May direct-to-consumer genetic testing have an impact on general practitioners’ daily practice? a cross-sectional study of patients’ intentions towards this approach

Abstract Background Direct-to-consumer genetic testing (DTCGT) offers individuals access to information on their probable risks of suffering from a wide range of chronic diseases. General practitioners (GPs) will probably play a major role in supporting its use, but patients’ perception of DTCGT remain unclear. This study aimed to describe those attitudes and expectations and how they might affect GPs’ daily practices. Methods In 2018–2019, a study related to the use of DTCGT for preventive care in general medicine was conducted among patients in Switzerland’s French-speaking areas. Data were collected in the waiting room using a self-administrated questionnaire about patients’ interest in DTCGT and what their attitudes might be if testing revealed an elevated risk of diabetes, colorectal cancer, or Alzheimer’s disease. Results About 40% of the 929 participating (participation rate about 80%) patients had heard about DTCGT and, once the test had been explained, 43% reported that they would be interested in being tested. If that testing suggested an elevated risk of disease, the majority of patients reported that they would change their lifestyle (65%–81%, depending on the disease), request more examinations (63%–77%), and expect changes in their GP’s follow-up (48%–59%). Personal characteristics such as sex, age, urbanity, marital status, and perceived health were factors predictive of patients’ attitudes. Conclusion Findings indicated that the generalization of DTCGT might affect GPs’ daily practices in terms of workload and knowledge about this approach. However, this result must be qualified by the fact that it is based on hypothetical situations.

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Regional differences in general practitioners’ behaviours regarding influenza vaccination: a cross-sectional study

BMC Health Services Research ◽

10.1186/s12913-021-06177-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jonathan Arlt ◽

Kristina Flaegel ◽

Katja Goetz ◽

Jost Steinhaeuser

Keyword(s):

Influenza Vaccination ◽

General Practitioners ◽

Personal Characteristics ◽

Cross Sectional Study ◽

Central Research Institute ◽

World Health ◽

Central Research ◽

Cross Sectional ◽

Vaccination Rates ◽

Health Organization

Abstract Background The World Health Organization recommends vaccination rates of 75% against seasonal influenza for patients over 65 years old. In the 2013/2014 season, the German vaccination rates ranged between 14 and 65%. This study aimed to compare the attitudes, personal characteristics and vaccination behaviours of general practitioners (GPs) in regions with high and low vaccination rates in Germany. Methods In May 2016, a questionnaire was sent to 1594 GPs practising in 16 districts with the highest and the lowest vaccination rates in Western and Eastern Germany as described by the Central Research Institute of Ambulatory Health Care in Germany for the 2013/2014 season. Descriptive statistics and multiple regression analyses were computed to identify potential factors associated with high vaccination rates. Results A total response rate of 32% (515/1594 participants) was observed in the study. GPs reported their attitudes towards vaccination in general and vaccination against influenza as mostly ‘very positive’ (80%, n = 352 and 65%, n = 288, respectively). GPs practising in regions with low vaccination rates reported their attitudes towards vaccinations in general (p = 0.004) and towards influenza vaccination (p = 0.001) more negatively than their colleagues from regions with high vaccination rates. Multiple logistic regression identified an increasing influence of year-dependent changing efficiency on GPs’ influenza rates as the strongest factor for predicting GPs from highly vaccinating regions (OR = 4.31 [1.12–16.60]), followed by the patient’s vaccination refusal despite GP advice due to already receiving a vaccination from another physician (OR = 3.20 [1.89–5.43]) and vaccination information gathering through medical colleagues (OR = 2.26 [1.19–4.29]). Conclusions The results of this study suggest a correlation between GPs’ attitudes and regional vaccination rates. Beneath GPs’ individual attitudes, the regional attitude patterns of patients, colleagues and medical assistants surrounding those GPs seem decisive and should be integrated into future campaigns to increase vaccination rates at a regional level.

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Correlation of education, age, and health insurance status with attitudes about and preferences for direct-to-consumer BRCA testing

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e22116 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e22116-e22116

Author(s):

S. W. Gray ◽

D. Smith ◽

L. Karp ◽

C. O'Grady ◽

R. Hornik ◽

...

Keyword(s):

Health Insurance ◽

Genetic Testing ◽

Online Survey ◽

Participation Rate ◽

Brca Testing ◽

High Quality ◽

Convenience Sample ◽

Health Insurance Status ◽

Direct To Consumer ◽

Positive Attitudes

e22116 Background: Direct-to-consumer (DTC) cancer genetic testing is increasingly common. However, little is know about peoples' attitudes about or preferences for DTC testing as compared to clinic-based genetic testing. Methods: We surveyed a convenience sample of 257 women without prior BRCA testing/counseling experience about their attitudes about and intentions to get online BRCA testing (90% participation rate). Subjects completed baseline interviews, viewed a modified commercial DTC website and completed an online survey. Results: Sample characteristics: mean age 37 (range 19–71), 80% white, mean education 3 years college, 45% with a household income <$50,000, 3% with a history of breast/ovarian cancer and mean Frank risk 4.7%. 64% of women expressed interest in BRCA testing at baseline and 24% intended to get tested in the next year. After viewing the website, 22% of women said that they would prefer DTC testing, 60% said that they would prefer clinic-based testing and 18% were indifferent. Overall, women believed that DTC testing would be more convenient (p <0.001), offer greater privacy (p <0.01), and be less likely to lead to discrimination (p <0.001) while clinic testing would provide more information (p <0.001) and counseling (p <0.001). After adjusting for confounders, older and less highly educated women had more positive attitudes about DTC BRCA testing (adjusted odds ratio (OR) 4.20, p= 0.02 and OR 10.3, p=0.03 high school (HS) vs. college and OR 16.1, p=0.02 HS vs. graduate school). Women with no health insurance and more positive attitudes about DTC genetic testing were more likely to prefer DTC genetic testing over clinic testing (adjusted OR 3.1, p=0.03 and OR 3.7, p<0.01). There were no associations between race and outcomes. Conclusions: A substantial minority of women expressed a preference for DTC BRCA testing after viewing a modified commercial website. Preferential interest in DTC testing by less educated and uninsured populations makes it especially critical that these sites provide high quality services. Without high quality service, the availability of DTC testing may only exacerbate disparities in genetic services and prevention. No significant financial relationships to disclose.

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Improving quality of care by obtaining patient-reported outcomes (PRO)-CTCAE chemotoxicities using tablet technology in daycare (DC) waiting rooms.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.165 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 165-165 ◽

Cited By ~ 1

Author(s):

Tian Qi Wang ◽

Catherine Brown ◽

Ashlee Vennettilli ◽

Lauren Wong ◽

Aein Zarrin ◽

...

Keyword(s):

Quality Of Care ◽

Time Frame ◽

Patient Reported Outcome ◽

Waiting Room ◽

Cross Sectional ◽

Hematologic Cancer ◽

Wide Range ◽

Patient Reported ◽

Age Range

165 Background: In a busy chemo DC, any efficient means of tracking important chemotoxicities can improve quality of care. The study goal was to evaluate whether tablet technology available in a DC waiting room is able to capture prevalent and severe toxicities associated with chemotherapy using the patient reported outcome (PRO) - common toxicity criteria for adverse events (CTCAE). Methods: This cross-sectional PRO-CTCAE study of 160 adult solid/hematologic cancer outpatients of all stages, who were undergoing chemotherapy (CT), focused on common chemotoxicities captured using touchscreen tablets in the DC waiting room of Princess Margaret Cancer Centre (Toronto, CA). Individual health scores from the EQ-5D VAS tool and the prevalence of AEs experienced by cancer patients within the past seven days were captured. Symptoms that were listed as moderate to very severe were considered significant. Results: Across a wide range of tumours and patients on intravenous CT, the median age (range) was 56 (19-88) years; 38% were males.Patients reported a median (range) health score (100 = best health possible, 0 = worst) of 70 (4-100). The severity offiveprevalent, key side-effects of CT were tabulated (Table). 59% of patients felt their fatigue interfered significantly with their daily activities, and 30% felt decreased appetite interfered significantly. 32% experienced nausea occasionally to almost constantly. Conclusions: The common symptoms of CT were captured FEASIBLY, and found to be highly prevalent in this CT-treated population. Capturing additional symptom prevalence outside of the 7-day time frame may be important from a clinical standpoint. Administration of PRO-CTCAE instrument through tablet technology may be an excellent method to help collect such data systematically and reliably. Updated data on 300 patients will be presented at the meeting. [Table: see text]

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Commodification and marketisation of genetic testing through online direct-to-consumer platforms in Hong Kong

Discourse & Communication ◽

10.1177/1750481317726926 ◽

2017 ◽

Vol 11 (6) ◽

pp. 630-647 ◽

Cited By ~ 1

Author(s):

Olga Zayts ◽

Zhengpeng Luo

Keyword(s):

Hong Kong ◽

Genetic Testing ◽

Hereditary Cancer ◽

General Public ◽

General Medicine ◽

Clinical Genetic ◽

Aptitude Tests ◽

Health And Wellbeing ◽

Direct To Consumer ◽

Online Platforms

In this article we examine commodification and marketisation of genetic testing by companies offering direct-to-consumer (DTC) genetic testing to the general public through online platforms in Hong Kong. Recently, offers of genetic testing have expanded from scientific and clinical genetic settings to general medicine (e.g. in hereditary cancer) and non-medical domains (e.g. aptitude tests). The wider availability of tests, however, has raised concerns about the currently available scientifically proven utility of these tests. Using theme-oriented discourse analysis, we analyse the specific discursive modalities through which the DTC companies in Hong Kong make inflated claims about the value of genetic tests to pursue their marketing agenda. We show that in this way the companies are selling ‘more’ than specific products to consumers: they are selling ‘hope’ and ‘increased autonomy’, that is, an opportunity to buy commodities online that promise consumers control of their health and wellbeing.

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Preeclampsia and Future Cardiovascular Risk: Are Women and General Practitioners Aware of This Relationship? The Experience from a Portuguese Centre

Obstetrics and Gynecology International ◽

10.1155/2014/531539 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Pedro Viana Pinto ◽

Mariana Rei ◽

Ana Paula Machado ◽

Nuno Montenegro

Keyword(s):

Cardiovascular Risk ◽

Aerobic Exercise ◽

General Practitioners ◽

Participation Rate ◽

Study Data ◽

Lifestyle Changes ◽

Chronic Hypertension ◽

Cross Sectional ◽

Weight Variation ◽

The Impact

Objective. To evaluate the impact of preeclampsia in the modification of lifestyle habits and decreasing cardiovascular risk factors in a population of women at least 6 months after having the diagnosis of preeclampsia.Methods. Cross-sectional observational study. Data included 141 cases of preeclampsia and chronic hypertension with superimposed preeclampsia on singleton births diagnosed in our institution between January 2010 and December 2013. From the cases diagnosed over 6 months a standardized questionnaire evaluating lifestyle changes was applied.Results. We reviewed 141 cases, of which 120 were diagnosed for more than 6 months. An overall participation rate in the questionnaire of 65% was yielded. A slight increase from the mean BMI before pregnancy was found. No statistical significant association was established between postpregnancy mean BMI, weight variation, and the frequency of aerobic exercise with the severity of preeclampsia. Only 28% of our cases were practising aerobic exercise at least weekly. The majority of women assessed blood pressure at least monthly (45/78), but only 25 assessed glycaemia at least once/year.Conclusion. This study shows that the majority of our patients and general practitioners do not take into consideration a previous pregnancy affected by preeclampsia as a risk factor for future cardiovascular disease.

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Burnout in French General Practitioners: A Nationwide Prospective Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182212044 ◽

2021 ◽

Vol 18 (22) ◽

pp. 12044

Author(s):

Frédéric Dutheil ◽

Lenise M. Parreira ◽

Julia Eismann ◽

François-Xavier Lesage ◽

David Balayssac ◽

...

Keyword(s):

Risk Factors ◽

Protective Factors ◽

General Practitioners ◽

Private Practice ◽

Personal Characteristics ◽

Maslach Burnout Inventory ◽

Cross Sectional Study ◽

Resident Training ◽

Group Practice ◽

Cross Sectional

Background: We aimed to evaluate the prevalence of burnout among French general practitioners in private practice and to study the risk and protective factors of burnout. Methods: A nationwide cross-sectional study was conducted with French GPs working in a private practice in France who were asked to fulfil an internet questionnaire. We used the secure internet application REDCap®. Exclusion criteria were only working in a hospital, substitute doctors, and internship students. There was a putative sample size of 88,886 GPs. We retrieved the Maslach Burnout Inventory (MBI), occupational characteristics (type of installation, emergency regulated shifts, night shifts, university supervisor, weekly hours worked, seniority), and personal characteristics such as age, gender, marital status, and number of children. Results: We included 1926 GPs among the 2602 retrieved questionnaires. A total of 44.8% of French liberal GPs were experiencing burnout, with 4.8% (95%CI 3.9–5.9%) experiencing severe burnout. The risk factors of severe burnout were male gender (RR = 1.91, 95%CI 1.15–3.16), working in a suburban area (5.23, 2.18–12.58), and having more than 28 appointments per day (1.95, 1.19–3.19). Working more than 50 h weekly showed a tendency to increase the risk of severe burnout (1.55, 0.93–2.59, p = 0.095), with a significant increase in the risk of low and moderate burnout (1.31, 1.02–1.67 and 1.86, 1.34–2.57, respectively). Protective factors were mainly resident training, which decreased the risk of both low, moderate, and severe burnout (0.65, 0.51–0.83; 0.66, 0.48–0.92; and 0.42, 95%CI 0.23–0.76, respectively). Performing home visits decreased the risk of severe burnout (0.25, 0.13–0.47), as did group practice for intermediate level of burnout (0.71, 0.51–0.96). Conclusion: GPs are at a high risk of burnout, with nearly half of them in burnout, with burnout predominantly affecting males and those between the ages of 50 and 60 years old. The main risk factors were a high workload with more than 28 appointments per day or 50 h of work per week, and the main protective factors were related to social cohesion such having a teaching role and working in a group practice with back-office support.

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The use of ultrasound in primary care: Longitudinal billing and cross-sectional survey study in Switzerland

10.21203/rs.3.rs-18174/v2 ◽

2020 ◽

Author(s):

Dima Touhami ◽

Christoph Merlo ◽

Joachim Hohmann ◽

Stefan Essig

Keyword(s):

Primary Care ◽

Survey Data ◽

General Practitioners ◽

Survey Study ◽

Cross Sectional Survey ◽

Billing Data ◽

Cross Sectional ◽

Clinical Indications ◽

Organ Systems ◽

Wide Range

Abstract Background Ultrasound imaging is utilized in Swiss primary care; however, little is known regarding the extent to which it is performed. With this study, we aim to (1) provide an overview of ultrasound use by general practitioners (GPs), and (2) determine the clinical indications of ultrasound in Swiss general practice.Methods This is a quantitative study, analyzing fifteen years of billing data from 213 GPs in Central Switzerland, and cross-sectional survey data completed by 61 GPs attending 26 certification and refresher courses offered by the Swiss Society of Ultrasound in Medicine (SGUM).Results According to billing data, 49% of the GPs used ultrasound and provided 130,245 exams to 67,180 patients between 2004 and 2018. Over the years, ultrasound use became more frequent among GPs. Male GPs provide more ultrasound exams than female GPs. Patients that are female, ≥65 years, and multi-morbid had more ultrasound exams compared to males, patients <65 years, and those with only one morbidity, respectively. GPs provided a mean of 129 ultrasound exams per physician-year. Abdominal ultrasound comprised almost 69% of all exams. According to survey data, indications covered many organ systems and clinical conditions, with abdominal indications being most frequent among them.Conclusions The use of ultrasound is high among general practitioners and it covers a wide range of clinical indications. Ultrasound is utilized primarily in the diagnosis of clinical indications of the abdomen, and more often for female than male patients.

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Factors Associated with the Acceptance and Willingness of COVID-19 Vaccination among Chinese Healthcare Workers

10.1101/2021.05.15.21257094 ◽

2021 ◽

Author(s):

Xinxin Ye ◽

Wan Ye ◽

Jinyue Yu ◽

Yuzhen Gao ◽

Ziyang Ren ◽

...

Keyword(s):

Healthcare Workers ◽

Vaccine Coverage ◽

Personal Characteristics ◽

Vaccine Hesitancy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Vaccination Rates ◽

Factors Associated ◽

Wide Range ◽

The Government

Background: Vaccination is a crucial measure in preventing the spread of epidemic. Vaccines targeting coronavirus disease 2019 (COVID-19) have been developed in a wide range of countries. Objective: This study aims to examine factors influencing vaccination rate and willingness to vaccinate against COVID-19 among Chinese healthcare workers (HCWs). Methods: From 3rd February to 18th February, 2021, an online cross-sectional survey was conducted among HCWs to investigate factors associated with the acceptance and willingness of COVID-19 vaccination. Respondents were classified into two categories, vaccinated and unvaccinated, and, the willingness of vaccination was assessed in the unvaccinated group. Information on socio-demographics and the psychological process of the participants for accepting the vaccine were evaluated. Results: A total of 2156 HCWs from 21 provinces in China responded to this survey (response rate: 98.99%)), among whom 1433 (66.5%) were vaccinated at least one dose. Higher vaccination rates were associated with older age (40-50 years vs. less than 30 years, OR=1.63, 95%CI: 1.02-2.58; >50 years vs. 30 years, OR=1.90, 95%CI: 1.02-3.52), working as a clinician (OR=1.54, 95% CI: 1.05-2.27), having no personal religion (OR=1.35, 95%CI: 1.06-1.71), working in a fever clinic (OR=4.50 , 95%CI:1.54-13.17) or higher hospital level(Municipal vs. County, OR=2.01, 95%CI: 1.28-3.16; Provincial vs. County, OR=2.01, 95%CI: 1.25-3.22) and having knowledge training of vaccine (OR=1.67, 95%CI:1.27-2.22), family history for influenza vaccination (OR=1.887, 95%CI:1.49-2.35) and strong familiarity with the vaccine (OR=1.43, 95%CI:1.05-1.95) (All P<0.05). Strong willingness for vaccination was related to having a working in midwestern China (OR=1.89, 95%CI:1.24-2.89), considerable knowledge of the vaccine (familiar vs. not familiar, OR=1.67, 95%CI: 1.17-2.39; strongly familiar vs. not familiar, OR=2.47, 95%CI: 1.36-4.49), knowledge training of vaccine(OR=1.61, 95%CI: 1.05-2.48) and strong confidence in the vaccine (OR=3.84 , 95%CI: 2.09-7.07). Conclusion: Personal characteristics, working environments, familiarity and confidence in the vaccine were related to vaccination rates and willingness to get vaccinated among healthcare workers. Results of this study could provide evidence for the government to improve vaccine coverage by addressing vaccine hesitancy in the COVID-19 pandemic and future public health emergencies.

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General Practitioners’ Practice premises and Risk of Viral Cross-Transmission: A French Observational Multicenter Study

Journal of Primary Care & Community Health ◽

10.1177/21501327211043734 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110437

Author(s):

Guillaume Daubert ◽

Gregoire Gillet ◽

Laurence Guet ◽

Helene Marini ◽

Veronique Merle

Keyword(s):

General Practitioners ◽

Standard Precautions ◽

Waiting Room ◽

Cross Sectional ◽

Multicenter Observational Study ◽

Surgical Masks ◽

Practice Organization ◽

Cross Transmission ◽

Risk Patients ◽

The Common

Background: The common areas of general practitioners’ practices (eg, reception, secretariat, waiting room, toilets) are places at risk of cross-transmission of viral diseases such as COVID-19, however risk is poorly documented. Aim: To evaluate the risks of viral cross-transmission in general practitioners’ practices based on the organization of the common areas of the premises. Design and setting: Cross-sectional multicenter observational study in randomly selected general practitioners’ practices in a French department (Seine-Maritime). The practices were included in 4 strata (1, 2, 3–5, or ≥6 general practitioners). Method: Each practice was visited and a questionnaire describing practice organization, cleaning of the premises, screening of high-risk patients was completed on site and observation of the premises). Results: Data collection started in December 2019 and was discontinued due to the national lockdown related to the global SARS-CoV-2 pandemic. Eighty-two practices were analyzed. A hydroalcoholic solution was available in 7.3% of practices and surgical masks in 1.2%. In a majority of waiting rooms, the minimum distance between chairs facing each other was >2 m (78.0%), but was more frequently 1 m for chairs at 90° (53.7%). Overall, 79.3% of waiting rooms could be properly ventilated and waste bins were present in 23.9% of cases. A cleaning protocol was reported in 39.2% of practices. Conclusion: The COVID-19 epidemic allowed the national dissemination of standard precautions. It will be interesting to monitor over the next few years whether the renewed consideration of standard precautions to prevent viral cross-contamination will be maintained over time.

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General practitioners’ and psychiatrists’ attitudes towards antidepressant withdrawal

BJPsych Open ◽

10.1192/bjo.2020.48 ◽

2020 ◽

Vol 6 (4) ◽

Author(s):

Joanne McCabe ◽

Mike Wilcock ◽

Kate Atkinson ◽

Richard Laugharne ◽

Rohit Shankar

Keyword(s):

Lived Experience ◽

General Practitioners ◽

Current Knowledge ◽

Community Pharmacists ◽

Cross Sectional Study ◽

Withdrawal Symptoms ◽

Cross Sectional ◽

Attitudes And Practices ◽

Wide Range ◽

Knowledge Attitudes And Practices

Background There has been a recent rise in antidepressant prescriptions. After the episode for which it was prescribed, the patient should ideally be supported in withdrawing the medication. There is increasing evidence for withdrawal symptoms (sometimes called discontinuation symptoms) occurring on ceasing treatment, sometimes having severe or prolonged effects. Aims To identify and compare current knowledge, attitudes and practices of general practitioners (GPs) and psychiatrists in Cornwall, UK, concerning antidepressant withdrawal symptoms. Method Questions about withdrawal symptoms and management were asked of GPs and psychiatrists in a multiple-choice cross-sectional study co-designed with a lived experience expert. Results Psychiatrists thought that withdrawal symptoms were more severe than GPs did (P = 0.003); 53% (22/42) of GPs and 69% (18/26) of psychiatrists thought that withdrawal symptoms typically last between 1 and 4 weeks, although there was a wide range of answers given; 35% (9/26) of psychiatrists but no GPs identified a pharmacist as someone they may use to help manage antidepressant withdrawal. About three-quarters of respondents claimed they usually or always informed patients of potential withdrawal symptoms when they started a patient on antidepressants, but patient surveys say only 1% are warned. Conclusions Psychiatrists and GPs need to effectively warn patients of potential withdrawal effects. Community pharmacists might be useful in supporting GP-managed antidepressant withdrawal. The wide variation in responses to most questions posed to participants reflects the variation in results of research on the topic. This highlights a need for more reproducible studies to be carried out on antidepressant withdrawal, which could inform future guidelines.

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