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Eating disorders (EDs) are a significant public health concern, yet men remain underrepresented in research and care, partly due to stigmatization. This stigmatization contributes to reduced help-seeking and recognition of ED symptoms in men. To address this, targeted interventions for healthcare professionals are needed. The iSMEsH intervention aims to sensitize general practitioners (GPs) in Germany to EDs in men, impart relevant knowledge and skills, and counter the perception of EDs as \"women's diseases\". We will evaluate the iSMEsH intervention regarding its effects on biased attitudes, knowledge, and self-efficacy among GPs. A sequential explanatory mixed-methods design (QUAN → qual) will be applied in three steps: (1) pre-implementation focus groups and a panel discussion with individuals with lived ED experience and GPs to design the intervention, (2) conduction of a randomized, wait-list controlled trial of the online training trial with GPs and medical students, and (3) post-implementation qualitative interviews with GPs. Quantitative data (step 2) will be analyzed using mixed-measures ANOVAs and contrast analyses (per-protocol) as well as corresponding 2 × 3 linear mixed models with fixed and random effects (intention-to-treat). Qualitative data from step 3 will be analyzed using thematic analysis as outlined by Braun and Clarke (2006). Ethical approval was granted by the Ruhr-University Bochum Ethics Committee (AZ 2023-1106). Participants will provide written or digital informed consent. The intervention seeks to reduce stigma against men with EDs in primary care by improving GPs' and medical students' knowledge, attitudes, and self-efficacy. Strengths include the comprehensive mixed-methods approach and involvement of people with lived experience. Limitations are reliance on self-report and short-/intermediate-term outcomes. If effective, iSMEsH may offer a foundation for future stigma-reduction strategies in healthcare.

Colorectal cancer (CRC) is a significant contributor to cancer-related burden, ranking second in cancer mortality in France. Despite the proven survival benefits of systematic CRC screening, uptake remains suboptimal, particularly among people with limited health literacy (HL) and lower socioeconomic position. This study aimed to assess the acceptability of an e-learning training programme on HL and CRC screening among general practitioners (GPs) in deprived areas while also exploring strategies for its promotion and scale-up. A qualitative study nested within the DECODE cluster-randomised controlled trial (NCT04631692) across four French regions was conducted. Semi-structured interviews (phone or online) were carried out to capture opinions, experiences, and recommendations of GPs in the intervention arm. Thematic analysis, employing manual and NVivo coding, was performed. The majority of 22 GPs (16/22) found the training acceptable, informative, tailored to their knowledge needs and offering great flexibility of use. The module on HL garnered more interest than the one on CRC screening, as it addressed a relatively new area for many GPs. It facilitated reflection on patient communication techniques and identified areas for improvement in physician-patient interaction. A perceived gap in the training was the insufficient interactivity in both didactic and virtual group sessions. The findings of this study show high acceptability of the e-learning training by participants, indicating a potential for implementation, if kept concise, self-paced, asynchronous, and with a stronger focus on HL. The training helped GPs reflect on their practices, enhance HL knowledge, and improve patient communication strategies, leading some to adopt new techniques in daily interactions with low HL patients, beyond just screening.

Unnecessary antibiotic prescribing contributes to antimicrobial resistance. In this trial, we aimed to reduce unnecessary prescriptions of antibiotics by general practitioners (GPs) in England. In this randomised, 2 × 2 factorial trial, publicly available databases were used to identify GP practices whose prescribing rate for antibiotics was in the top 20% for their National Health Service (NHS) Local Area Team. Eligible practices were randomly assigned (1:1) into two groups by computer-generated allocation sequence, stratified by NHS Local Area Team. Participants, but not investigators, were blinded to group assignment. On Sept 29, 2014, every GP in the feedback intervention group was sent a letter from England's Chief Medical Officer and a leaflet on antibiotics for use with patients. The letter stated that the practice was prescribing antibiotics at a higher rate than 80% of practices in its NHS Local Area Team. GPs in the control group received no communication. The sample was re-randomised into two groups, and in December, 2014, GP practices were either sent patient-focused information that promoted reduced use of antibiotics or received no communication. The primary outcome measure was the rate of antibiotic items dispensed per 1000 weighted population, controlling for past prescribing. Analysis was by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN32349954, and has been completed. Between Sept 8 and Sept 26, 2014, we recruited and assigned 1581 GP practices to feedback intervention (n=791) or control (n=790) groups. Letters were sent to 3227 GPs in the intervention group. Between October, 2014, and March, 2015, the rate of antibiotic items dispensed per 1000 population was 126·98 (95% CI 125·68–128·27) in the feedback intervention group and 131·25 (130·33–132·16) in the control group, a difference of 4·27 (3·3%; incidence rate ratio [IRR] 0·967 [95% CI 0·957–0·977]; p<0·0001), representing an estimated 73 406 fewer antibiotic items dispensed. In December, 2014, GP practices were re-assigned to patient-focused intervention (n=777) or control (n=804) groups. The patient-focused intervention did not significantly affect the primary outcome measure between December, 2014, and March, 2015 (antibiotic items dispensed per 1000 population: 135·00 [95% CI 133·77–136·22] in the patient-focused intervention group and 133·98 [133·06–134·90] in the control group; IRR for difference between groups 1·01, 95% CI 1·00–1·02; p=0·105). Social norm feedback from a high-profile messenger can substantially reduce antibiotic prescribing at low cost and at national scale; this outcome makes it a worthwhile addition to antimicrobial stewardship programmes. Public Health England.

Background Patients with advanced chronic non-malignant conditions often experience significant symptom burden. Therefore, overcoming barriers to interprofessional collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams is essential to facilitate the timely integration of palliative care elements. The KOPAL trial aimed to examine the impact of case conferences between GPs and SPHC teams on symptom burden and pain in patients with advanced chronic heart failure, chronic obstructive pulmonary disease, and dementia. Methods The cluster-randomised controlled trial compared a structured palliative care nurse visit followed by an interprofessional case conference to usual care. Data were collected from GPs at baseline and 48 weeks, while standardised patient interviews were conducted at baseline, 6, 12, 24, and 48 weeks. Results We analysed 172 patients from 49 German GP practices. Both groups showed marginal improvement in symptom burden; however, no statistically significant between-group difference was found ( =-0.561, 95% CI: -3.201–2.079, p  = .68). Patients with dementia experienced a significant pain reduction ( =2.187, 95% CI: 0.563–3.812, p  = .009). Conversely, the intervention did not have a significant effect on pain severity ( =-0.711, 95% CI: -1.430 − 0.008, p =.053) or pain interference ( =-0.036, 95% CI:-0.797 − 0.725, p =.926) in other patient groups. Conclusions The intervention showed promise in the timely introduction of palliative care elements to address pain management in patients with dementia. Further studies are needed to identify and effectively address symptom burden and pain in other patient groups. Trial registration German Clinical Trials Register: https://www.drks.de/DRKS00017795 (Registration date: 9th January 2020).

ABSTRACT BACKGROUND Evidence shows a high rate of unnecessary antibiotic prescriptions in primary care in Europe and the United States. Given the costs of widespread use and associated antibiotic resistance, reducing inappropriate use is a public health priority. OBJECTIVE We aimed to explore clinicians’ experiences of training in communication skills and use of a patient booklet and/or a C-reactive protein (CRP) point-of-care test to reduce antibiotic prescribing for acute respiratory tract infections (RTIs). DESIGN We used a qualitative research approach, interviewing clinicians who participated in a randomised controlled trial (RCT) testing two contrasting interventions. PARTICIPANTS General practice clinicians in Belgium, England, The Netherlands, Poland, Spain and Wales participated in the study. APPROACH Sixty-six semi-structured interviews were transcribed verbatim, translated into English where necessary, and analysed using thematic and framework analysis. KEY RESULTS Clinicians from all countries attributed benefits for themselves and their patients to using both interventions. Clinicians reported that the communication skills training and use of the patient booklet gave them greater confidence in addressing patient expectations for an antibiotic by providing answers to common questions and supporting the clinician’s own explanations. Clinicians felt the booklet could be used for a variety of patients and for different types of infections. The CRP test was viewed as a tool to decrease diagnostic uncertainty, to support non-prescription decisions, and to reassure patients, but was only necessary when clinicians were uncertain about the need for antibiotics. CONCLUSION Providing clinicians with training and support tools for use in practice was received positively and was valued by clinicians across countries. Interventions seemed to have influenced behaviour by increasing clinician knowledge about illness severity and prescribing, increasing confidence in making non-prescribing decisions when antibiotics were unnecessary, and enabling clinicians to anticipate positive outcomes when making such decisions. Addressing such determinants of behaviour change enabled interventions to be relevant for clinicians working across different contexts.

There is a rising prevalence of multimorbidity, particularly in older patients, and a need for evidence-based medicines management interventions for this population. The Supporting Prescribing in Older Adults with Multimorbidity in Irish Primary Care (SPPiRE) trial aimed to investigate the effect of a general practitioner (GP)-delivered, individualised medication review in reducing polypharmacy and potentially inappropriate prescriptions (PIPs) in community-dwelling older patients with multimorbidity in primary care. We conducted a cluster randomised controlled trial (RCT) set in 51 GP practices throughout the Republic of Ireland. A total of 404 patients, aged ≥65 years with complex multimorbidity, defined as being prescribed ≥15 regular medicines, were recruited from April 2017 and followed up until October 2020. Furthermore, 26 intervention GP practices received access to the SPPiRE website where they completed an educational module and used a template for an individualised patient medication review that identified PIP, opportunities for deprescribing, and patient priorities for care. A total of 25 control GP practices delivered usual care. An independent blinded pharmacist assessed primary outcome measures that were the number of medicines and the proportion of patients with any PIP (from a predefined list of 34 indicators based predominantly on the STOPP/START version 2 criteria). We performed an intention-to-treat analysis using multilevel modelling. Recruited participants had substantial disease and treatment burden at baseline with a mean of 17.37 (standard deviation [SD] 3.50) medicines. At 6-month follow-up, both intervention and control groups had reductions in the numbers of medicines with a small but significantly greater reduction in the intervention group (incidence rate ratio [IRR] 0.95, 95% confidence interval [CI]: 0.899 to 0.999, p = 0.045). There was no significant effect on the odds of having at least 1 PIP in the intervention versus control group (odds ratio [OR] 0.39, 95% CI: 0.140 to 1.064, p = 0.066). Adverse events recorded included mortality, emergency department (ED) presentations, and adverse drug withdrawal events (ADWEs), and there was no evidence of harm. Less than 2% of drug withdrawals in the intervention group led to a reported ADWE. Due to the inability to electronically extract data, primary outcomes were measured at just 2 time points, and this is the main limitation of this work. The SPPiRE intervention resulted in a small but significant reduction in the number of medicines but no evidence of a clear effect on PIP. This reduction in significant polypharmacy may have more of an impact at a population rather than individual patient level. ISRCTN Registry ISRCTN12752680.

The increasing prevalence of dermatological diseases will pose a growing challenge to the health care system and, in particular, to general practitioners (GPs) as the first point of contact for these patients. In many countries, primary care physicians are supported by teledermatology services. The aim of this study was to detect learning effects and gains among GPs through teledermatology consultations (TCs) in daily practice. As part of a mixed methods study embedded in a cluster-randomized controlled trial (TeleDerm), a full survey and semiguided face-to-face interviews were conducted among GPs of participating intervention practices using the telemedicine approach. A TC assessment tool (TC-AT) was developed to evaluate the quality of clinical data and images of TCs conducted during the run-in and intervention phases, with a score ranging from 0 (lowest quality) to 10 (highest quality). Mixed methods analysis triangulated qualitative content analysis, survey data with a growth curve model calculated from TC-AT data, comparing subjective experiences of GPs with objective process data. A total of 487 TCs of 33 practices were analyzed. Questionnaires from n=46 GPs (practice-level response rate: 69.9%) were included in the quantitative analysis. Two-thirds of the GPs (n=31; 67.4%) in the written survey rated the TCs as helpful for differential diagnosis and treatment management. Improved self-reported confidence in diagnosing skin diseases due to the timely clinical feedback from dermatologists was reported by more than half of the responding GPs (n=25; 54.3%). In the interviews (n=13), teleconsultations were mainly seen as a learning opportunity by the GPs. Regarding the quality of TCs, a mean TC-AT score of 7.4 (SD 1.7, range 0-10) was observed. In the growth curve model, a simple linear time trend provided the best fit to the TC-AT score trajectory across the observed study period. A significant time * TC-AT start score interaction was found (F452=30.66, P<.001). While regardless of the initial TC-AT score, repeated TCs lead to process quality improvements over time, post hoc probing of the TC-AT start score as a moderator of the learning effect over time revealed the highest improvements among GP practices with a lower initial TC-AT score (-1 SD: standardized slope=0.59, P<.001; mean: standardized slope=0.38, P<.001; +1 SD: standardized slope=0.18, P<.001). TCs have been shown to be an effective method of education for GPs in terms of \"learning on the job\" in daily practice. The telemedicine approach seems to be an easily implementable and effective tool to support continuing medical education in the field of dermatology. Strategies could be developed to train GPs and medical students in the use of TC to adequately prepare them for the increasing technological demands of their future profession in primary care.

The first contact for patients with obesity for any medical treatment or other issues is generally with General Practitioners (GPs). Therefore, given the complexity of the disease, continuing GPs’ education on obesity management is essential. This article aims to provide obesity management guidelines specifically tailored to GPs, favouring a practical patient-centred approach. The focus is on GP communication and motivational interviewing as well as on therapeutic patient education. The new guidelines highlight the importance of avoiding stigmatization, something frequently seen in different health care settings. In addition, managing the psychological aspects of the disease, such as improving self-esteem, body image and quality of life must not be neglected. Finally, the report considers that achieving maximum weight loss in the shortest possible time is not the key to successful treatment. It suggests that 5–10% weight loss is sufficient to obtain substantial health benefits from decreasing comorbidities. Reducing waist circumference should be considered even more important than weight loss per se, as it is linked to a decrease in visceral fat and associated cardiometabolic risks. Finally, preventing weight regain is the cornerstone of lifelong treatment, for any weight loss techniques used (behavioural or pharmaceutical treatments or bariatric surgery).

Background General Practitioners (GPs) are the main providers of primary palliative care (PPC). At the same time they are the main initiators of specialised palliative homecare (SPHC). In Germany, little is known about factors which influence GPs in their involvement of SPHC. Aim of our study is to identify factors that drive GPs to give value to and involve SPHC. Methods A cross-sectional survey was performed. In 2018, questionnaires were mailed to 6000 randomly selected GPs from eight German federal states, focusing on the extent of GPs’ palliative care activities and their involvement of SPHC. Results With a response rate of 19.4% and exclusion of GPs working in SPHC-teams, n  = 1026 questionnaires were appropriate for analysis. GPs valued SPHC support as the most “important/very important” for both “technical/invasive treatment measures” (95%) and availability outside practice opening hours (92%). The most relevant factor influencing perceived SPHC-importance was GPs’ self-reported extent of engagement in palliative care (β = − 0.283; CI 95% = − 0.384;−0.182), followed by the perceived quality of utilised SPHC (β = 0.119; CI 95% = 0.048;0.190), involvement in treatment of palliative patients after SPHC initiation (β = 0.088; CI 95% = 0.042;0.134), and conviction that palliative care should be a central part of GPs’ work (β = − 0.062; CI 95% = − 0.116;−0.008). Perceived SPHC-importance is also associated with SPHC-referrals (β =0.138; p  < 0.001). The lower the engagement of GPs in palliative care, the more they involve SPHC and vice versa. Conclusions GPs with low reported activity in palliative care are more likely to initialise SPHC for palliative care activities they do not deliver themselves for various reasons, which might mean that the involvement of SPHC is substitutive instead of complementary to primary palliative care. This finding and its interpretation should be given more attention in the future policy framework for (specialised) palliative homecare. Trial registration German Clinical Trials Register DRKS00014726 , 14.05.2018.

AbstractObjectivesTo compare the numbers and characteristics of English general practitioner doctors (GPs) across publicly available data sources, and to examine trends in GP numbers relative to population growth and the specialist medical workforce in England.DesignRepeat cross sectional study.SettingThree national data sources, England, 2012-24: General Medical Council (GMC) GP and specialist registers; NHS England GP Performers List; and NHS England’s General Practice Workforce and NHS Workforce Statistics datasets.ParticipantsAll GMC licensed, fully qualified GPs in England.Main outcome measuresDifferences over time in total numbers and GP characteristics. Changes in the difference between GMC and NHS general practice GP numbers and characteristics, and analysis of trends relative to population size and equivalent data on specialist doctors.ResultsAs of 31 December 2024, 58 548 GPs were listed on the GMC GP register, 55 958 on the Performers List, but only 38 626 by headcount and 28 197 by full time equivalent GPs in NHS general practice. Between 2015 and 2024, on average, for every five additional GPs licensed by the GMC, NHS general practice lost one full time equivalent GP each year. As a result, the proportion of GMC licensed GPs not working in NHS general practice increased from 27% (13 492) in 2015 to 34% (19 922) in 2024 by headcount and from 41% (20 210) to 52% (30 351) by full time equivalent GPs. Differences were greatest among female GPs, younger GPs, UK qualified GPs, and GPs in London and the South East of England. In contrast, between 2015 and 2024, for every five additional GMC licensed specialist doctors, the NHS gained 4.3 full time equivalent consultants. Taking population growth into account, the number of NHS patients for each full time equivalent GP in NHS general practice increased by15%, whereas the number of patients for each full time equivalent NHS consultant fell by 18%. By the end of 2024, there were twice as many NHS patients for each full time equivalent NHS general practice GP (2260) than for each full time equivalent NHS consultant (1092).ConclusionThe growing difference between GMC licensed GPs and those working in NHS general practice is in contrast with trends among specialists. This shift is occurring despite rising patient demand and policy commitments to strengthen primary care. Addressing the underlying reasons for workforce attrition in NHS general practice is critical to achieving the government’s stated goals of strengthening community based care and shifting the focus of care from treatment to prevention.