scholarly journals Acceptance of Telerheumatology by Rheumatologists and General Practitioners in Germany: Nationwide Cross-sectional Survey Study

10.2196/23742 ◽  
2021 ◽  
Vol 23 (3) ◽  
pp. e23742
Author(s):  
Felix Muehlensiepen ◽  
Johannes Knitza ◽  
Wenke Marquardt ◽  
Jennifer Engler ◽  
Axel Hueber ◽  
...  
Keyword(s):  
General Practitioners ◽  
Large Scale ◽  
Musculoskeletal Diseases ◽  
User Preferences ◽  
Survey Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Structural Framework ◽  
Full Capacity ◽  
Economic Analyses

Background The worldwide burden of musculoskeletal diseases is increasing. The number of newly registered rheumatologists has stagnated. Primary care, which takes up a key role in early detection of rheumatic disease, is working at full capacity. COVID-19 and its containment impede rheumatological treatment. Telemedicine in rheumatology (telerheumatology) could support rheumatologists and general practitioners. Objective The goal of this study was to investigate acceptance and preferences related to the use of telerheumatology care among German rheumatologists and general practitioners. Methods A nationwide, cross-sectional, self-completed, paper-based survey on telerheumatology care was conducted among outpatient rheumatologists and general practitioners during the pre-COVID-19 period. Results A total of 73.3% (349/476) of survey participants rated their knowledge of telemedicine as unsatisfactory, poor, or very poor. The majority of survey participants (358/480, 74.6%) answered that they do not currently use telemedicine, although 62.3% (291/467) would like to. Barriers to the implementation of telemedicine include the purchase of technology equipment (182/292, 62.3%), administration (181/292, 62.0%), and poor reimbursement (156/292, 53.4%). A total of 69.6% (117/168) of the surveyed physicians reckoned that telemedicine could be used in rheumatology. Surveyed physicians would prefer to use telemedicine to communicate directly with other physicians (370/455, 81.3%) than to communicate with patients (213/455, 46.8%). Among treatment phases, 64.4% (291/452) of participants would choose to use telemedicine during follow-up. Half of the participants would choose telecounseling as a specific approach to improve rheumatology care (91/170, 53.5%). Conclusions Before COVID-19 appeared, our results indicated generally low use but high acceptance of the implementation of telerheumatology among physicians. Participants indicated that the lack of a structural framework was a barrier to the effective implementation of telerheumatology. Training courses should be introduced to address the limited knowledge on the part of physicians in the use of telemedicine. More research into telerheumatology is required. This includes large-scale randomized controlled trials, economic analyses, and the exploration of user preferences.

scholarly journals Acceptance of Telerheumatology: Results of a nationwide Survey of Rheumatologists and General Practitioners (Preprint)

2020 ◽  
Author(s):  
Felix Muehlensiepen ◽  
Johannes Knitza ◽  
Wenke Marquardt ◽  
Jennifer Engler ◽  
Axel Hueber ◽  
...  
Keyword(s):  
General Practitioners ◽  
Large Scale ◽  
Musculoskeletal Diseases ◽  
Nationwide Survey ◽  
User Preferences ◽  
Cross Sectional ◽  
Structural Framework ◽  
Full Capacity ◽  
Training Courses ◽  
Economic Analyses

BACKGROUND The worldwide burden of musculoskeletal diseases is increasing. The number of newly registered rheumatologists has stagnated. Primary care, which takes up a key role in early detection of rheumatic disease is working at full capacity. COVID-19 and its containment impede rheumatological treatment. Telemedicine in rheumatology (telerheumatology) could support rheumatologists and general practitioners. OBJECTIVE To investigate acceptance and preferences related to the use of telerheumatology care among German rheumatologists and general practitioners. METHODS A nationwide cross-sectional, self-completed, paper-based survey on telemedicine in rheumatology care was conducted among outpatient rheumatologists and general practitioners (pre-COVID-19). RESULTS A total of 73% (349/476) of survey participants rated their knowledge of telemedicine as unsatisfactory, poor, or very poor. The majority of survey participants (358/480, 75%) answered that they do not currently use telemedicine, although 62% would like to (291/467). Barriers to the implementation of telemedicine include the purchase of technology equipment (182/292, 62%), administration (181/292, 62%) and poor reimbursement (156/292, 53%). Seventy percent (117/168) of the surveyed physicians reckoned telemedicine could be used in rheumatology. Surveyed physicians would prefer to use telemedicine to communicate directly with other physicians (370/455, 81%), than to communicate with patients (213/455, 47%). Among treatment phases, 64% of participants would choose to use telemedicine during ‘follow-up’ (291/452). Half of the participants would choose 'telecounseling' as a specific approach to improve rheumatology care (91/170, 54%). CONCLUSIONS Before COVID-19 appeared, our results indicated generally low use but high acceptance of the implementation of telerheumatology among physicians. Participants indicated that the lack of a structural framework was a barrier to the effective implementation of telerheumatology. Training courses should be introduced to address the limited knowledge of physicians in the use of telemedicine. More research into telerheumatology is required. This includes large scale RCTs, economic analyses and the exploration of the user preferences. CLINICALTRIAL

Acceptance, Use and Barriers of Telemedicine in times of SARS-CoV-2 in Transgender Health Care: Results of a nationwide cross-sectional survey (Preprint)

2021 ◽  
Author(s):  
Stefan Hertling ◽  
Doreen Hertling
Keyword(s):  
Health Care ◽  
Large Scale ◽  
Cross Sectional Study ◽  
User Preferences ◽  
Technical Equipment ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Transgender Health ◽  
Virtual Visits ◽  
Economic Analyses

BACKGROUND The global incidence in the treatment of transident people is increasing. In the COVID-19 pandemic, many consultations had to be cancelled, postponed or converted to a virtual format. Telemedicine in Transgender Health Care management could support physicians. OBJECTIVE This study analyses the Acceptance, Use and Barriers of Telemedicine in times of SARS-CoV-2 in Transgender Health Care in Germany. METHODS This prospective cross-sectional study was based on a survey of gynecological endocrinologists and transident patients in Germany during the COVID-19 pandemic. Descriptive statistics were calculated and regression analyses were performed to show correlations. RESULTS We analyzed the responses of 269 transident patients and 202 gynaecological endocrinologists treating transident patients. Most believed that telemedicine was useful. Physicians as well as patients rated their knowledge of telemedicine as unsatisfactory. The majority of respondents said they do not currently use telemedicine, although would like to do so. Patients and physicians reported that their attitude had changed positively towards telemedicine and that their usage had increased due to COVID-19. The majority in both groups agreed on implementing virtual visits in stable disease conditions. In the treatment phases, 74.4% (150/202) of the respondents would use telemedicine during follow-up. Half of the respondents would choose telecounseling as a specific approach to improving care (128/202, 63.2%). Obstacles to the introduction of telemedicine include the purchase of technical equipment (132/202, 65.3%), administration (124/202, 61.2%) and poor reimbursement (106/202, 52.4%). CONCLUSIONS Telemedicine in Transgender Health Care finds limited use but high acceptance among doctors and patients alike. The absence of a structured framework is an obstacle to effective implementation. Training courses should be introduced to improve the limited knowledge in the use of telemedicine. More research in teleendogynaecology is needed. These include large-scale randomized controlled trials, economic analyses and the exploration of user preferences.

Implementation of telemedicine in times of SARS-CoV-2 in gynecology and obstetrics: Results of a nationwide cross-sectional study (Preprint)

2021 ◽  
Author(s):  
Stefan Hertling ◽  
Franziska Loos ◽  
Isabel Graul
Keyword(s):  
Large Scale ◽  
Cross Sectional Study ◽  
User Preferences ◽  
Technical Equipment ◽  
Sectional Study ◽  
Cross Sectional ◽  
Gynecology And Obstetrics ◽  
Training Courses ◽  
Economic Analyses

BACKGROUND In the COVID-19 pandemic, many consultations had to be cancelled, postponed or converted to a virtual format. Telemedicine in gynaecology (telegynaecology) could support gynaecologists and obstetricians. OBJECTIVE This study analyses the use and perception of telemedicine applications among gynaecologists in Germany. METHODS This prospective cross-sectional study was based on a survey of gynaecologists in Germany during the COVID-19 pandemic. Descriptive statistics were calculated and regression analyses were performed to show correlations. RESULTS The physicians expect telemedicine to be used in gynecology and obstetrics. 76. 4% (365/478) of the respondents rated their knowledge of telemedicine as insufficient. The majority of respondents (437/478, 91. 6%) said they did not currently use telemedicine, although 67. 3% (321/478) would like to do so. Obstacles to the introduction of telemedicine include the purchase of technical equipment (325/478, 68. 1%), administration (305/478, 64. 0%) and poor reimbursement (233/478, 48. 9%). Doctors surveyed would prefer telemedicine to communicate directly with other doctors (388/478, 81. 2%) rather than to communicate with patients (228/478, 47. 8%). In the treatment phases, 73. 2% (349/478) of the respondents would use telemedicine during follow-up. Half of the respondents would choose tele-culting as a specific approach to improving care (246/478, 51. 5%). CONCLUSIONS Telemedicine in gynecology finds little use but high acceptance among doctors. The absence of a structured framework is an obstacle to effective implementation. Training courses should be introduced to improve the limited knowledge in the use of telemedicine. More research in telegynecology is needed. These include large-scale randomized controlled trials, economic analyses and the exploration of user preferences.

scholarly journals Suitability of Video Consultations During the COVID-19 Pandemic Lockdown: Cross-sectional Survey Among Norwegian General Practitioners

10.2196/26433 ◽  
2021 ◽  
Vol 23 (2) ◽  
pp. e26433
Author(s):  
Tor Magne Johnsen ◽  
Børge Lønnebakke Norberg ◽  
Eli Kristiansen ◽  
Paolo Zanaboni ◽  
Bjarne Austad ◽  
...  
Keyword(s):  
General Practitioners ◽  
Life Stress ◽  
Large Scale ◽  
Online Survey ◽  
Health Care Planning ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Face To Face ◽  
Relational Continuity

Background The COVID-19 pandemic imposed an acute, sharp rise in the use of video consultations (VCs) by general practitioners (GPs) in Norway. Objective This study aims to document GPs’ experiences with the large-scale uptake of VCs in the natural experiment context of the pandemic. Methods A nationwide, cross-sectional online survey was conducted among Norwegian GPs during the pandemic lockdown (April 14-May 3, 2020). Each respondent was asked to evaluate up to 10 VCs. Basic demographic characteristics of the GPs and their practices were collected. The associations between GPs’ perceived suitability of the VCs, the nature of the patients’ main problems, prior knowledge of the patients (relational continuity), and follow-up of previously presented problems (episodic continuity) were explored using descriptive statistics, diagrams, and chi-square tests. Results In total, 1237 GPs (26% of the target group) responded to the survey. Among these, 1000 GPs offered VCs, and 855 GPs evaluated a total of 3484 VCs. Most GPs who offered VCs (1000/1237; 81%) had no experience with VCs before the pandemic. Overall, 51% (1766/3476) of the evaluated VCs were considered to have similar or even better suitability to assess the main reason for contact, compared to face-to-face consultations. In the presence of relational continuity, VCs were considered equal to or better than face-to-face consultations in 57% (1011/1785) of cases, as opposed to 32% (87/274) when the patient was unknown. The suitability rate for follow-up consultations (episodic continuity) was 61% (1165/1919), compared to 35% (544/1556) for new patient problems. Suitability varied considerably across clinical contact reasons. VCs were found most suitable for anxiety and life stress, depression, and administrative purposes, as well as for longstanding or complex problems that normally require multiple follow-up consultations. The GPs estimate that they will conduct about 20% of their consultations by video in a future, nonpandemic setting. Conclusions Our study of VCs performed in general practice during the pandemic lockdown indicates a clear future role for VCs in nonpandemic settings. The strong and consistent association between continuity of care and GPs’ perceptions of the suitability of VCs is a new and important finding with considerable relevance for future primary health care planning.

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

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.

scholarly journals Facilitating smoking cessation in patients who smoke: a large-scale cross-sectional comparison of fourteen groups of healthcare providers

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
E. Meijer ◽  
R. M. J. J. Van der Kleij ◽  
N. H. Chavannes
Keyword(s):  
Smoking Cessation ◽  
General Practitioners ◽  
Large Scale ◽  
Smoking Status ◽  
Healthcare Providers ◽  
Regression Tree ◽  
Role Identity ◽  
Regression Analyses ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Background Although healthcare providers are well placed to help smokers quit, implementation of smoking cessation care is still suboptimal. The Ask-Advise-Refer tasks are important aspects of smoking cessation care. We examined to which extent a large and diverse sample of healthcare providers expressed the intention to implement smoking cessation care and which barriers they encountered. We moreover examined to which extent the Ask-Advise-Refer tasks were implemented as intended, and which determinants (in interaction) influenced intentions and the implementation of Ask-Advise-Refer. Methods Cross-sectional survey among addiction specialists, anaesthesiologists, cardiologists, general practitioners, internists, neurologists, paediatricians, pulmonologists, ophthalmologists, surgeons, youth specialists, dental hygienists, dentists, and midwives (N = 883). Data were analysed using multivariate linear and logistic regression analyses and regression tree analyses. Results The Ask-Advice-Refer tasks were best implemented among general practitioners, pulmonologists, midwives, and addiction specialists. Overall we found a large discrepancy between asking patients about smoking status and advising smokers to quit. Participants mentioned lack of time, lack of training, lack of motivation to quit in patients, and smoking being a sensitive subject as barriers to smoking cessation care. Regression analyses showed that the most important determinants of intentions and implementation of Ask-Advise-Refer were profession, role identity, skills, guideline familiarity and collaboration agreements for smoking cessation care with primary care. Determinants interacted in explaining outcomes. Conclusions There is much to be gained in smoking cessation care, given that implementation of Ask-Advise-Refer is still relatively low. In order to improve smoking cessation care, changes are needed at the level of the healthcare provider (i.e., facilitate role identity and skills) and the organization (i.e., facilitate collaboration agreements and guideline familiarity). Change efforts should be directed towards the specific barriers encountered by healthcare providers, the contexts that they work in, and the patients that they work with.

scholarly journals Suitability of Video Consultations During the COVID-19 Pandemic Lockdown: Cross-sectional Survey Among Norwegian General Practitioners (Preprint)

2020 ◽  
Author(s):  
Tor Magne Johnsen ◽  
Børge Lønnebakke Norberg ◽  
Eli Kristiansen ◽  
Paolo Zanaboni ◽  
Bjarne Austad ◽  
...  
Keyword(s):  
General Practitioners ◽  
Life Stress ◽  
Large Scale ◽  
Online Survey ◽  
Health Care Planning ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Face To Face ◽  
Relational Continuity

BACKGROUND The COVID-19 pandemic imposed an acute, sharp rise in the use of video consultations (VCs) by general practitioners (GPs) in Norway. OBJECTIVE This study aims to document GPs’ experiences with the large-scale uptake of VCs in the natural experiment context of the pandemic. METHODS A nationwide, cross-sectional online survey was conducted among Norwegian GPs during the pandemic lockdown (April 14-May 3, 2020). Each respondent was asked to evaluate up to 10 VCs. Basic demographic characteristics of the GPs and their practices were collected. The associations between GPs’ perceived suitability of the VCs, the nature of the patients’ main problems, prior knowledge of the patients (relational continuity), and follow-up of previously presented problems (episodic continuity) were explored using descriptive statistics, diagrams, and chi-square tests. RESULTS In total, 1237 GPs (26% of the target group) responded to the survey. Among these, 1000 GPs offered VCs, and 855 GPs evaluated a total of 3484 VCs. Most GPs who offered VCs (1000/1237; 81%) had no experience with VCs before the pandemic. Overall, 51% (1766/3476) of the evaluated VCs were considered to have similar or even better suitability to assess the main reason for contact, compared to face-to-face consultations. In the presence of relational continuity, VCs were considered equal to or better than face-to-face consultations in 57% (1011/1785) of cases, as opposed to 32% (87/274) when the patient was unknown. The suitability rate for follow-up consultations (episodic continuity) was 61% (1165/1919), compared to 35% (544/1556) for new patient problems. Suitability varied considerably across clinical contact reasons. VCs were found most suitable for anxiety and life stress, depression, and administrative purposes, as well as for longstanding or complex problems that normally require multiple follow-up consultations. The GPs estimate that they will conduct about 20% of their consultations by video in a future, nonpandemic setting. CONCLUSIONS Our study of VCs performed in general practice during the pandemic lockdown indicates a clear future role for VCs in nonpandemic settings. The strong and consistent association between continuity of care and GPs’ perceptions of the suitability of VCs is a new and important finding with considerable relevance for future primary health care planning.

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

2020 ◽  
Author(s):  
Dima Touhami ◽  
Christoph Merlo ◽  
Joachim Hohmann ◽  
Stefan Essig
Keyword(s):  
Primary Care ◽  
Survey Data ◽  
General Practitioners ◽  
Survey Study ◽  
Point Of Care Ultrasound ◽  
Cross Sectional Survey ◽  
Billing Data ◽  
Cross Sectional ◽  
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. A course in Point-of-Care ultrasound (POCUS) has been recently introduced to promote and improve the utilization of ultrasound. POCUS will offer faster certification compared to previous courses thanks to a limited set of targeted examinations. With this study, we aim to (1) provide an overview of ultrasound use by general practitioners (GPs), and (2) determine how the clinical uses of ultrasound relate to the targeted objectives of POCUS. 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 most POCUS indications being among them. Conclusions Utilization of ultrasound is high among general practitioners and covers a wide range of indications. A focus in certification on POCUS might reduce the variety of indications. Keywords: Ultrasound; general practice; primary care; general practitioners; clinical indications; POCUS; ultrasound certification; Switzerland

Telemedicine as a therapeutic option in sports medicine: Results of a nationwide cross-sectional study among physicians and patients (Preprint)

2021 ◽  
Author(s):  
Stefan Hertling
Keyword(s):  
Sports Medicine ◽  
Large Scale ◽  
Therapeutic Option ◽  
Cross Sectional Study ◽  
User Preferences ◽  
Sectional Study ◽  
Cross Sectional ◽  
Virtual Visits ◽  
Training Courses ◽  
Economic Analyses

BACKGROUND Background: The global incidence of treating people in the field of sports medicine is increasing. The COVID-19 pandemic has changed everyday life. Many consultations had to be cancelled, postponed or converted to a virtual format. Telemedicine in sports medicine could support physicians. OBJECTIVE The study analyses the use and perception of telemedicine applications among physicians and patients in the field of sports medicine in Germany. METHODS This prospective cross-sectional study was based on a survey of sports medicine physicians and patients in Germany during the COVID-19 pandemic. Descriptive statistics were calculated. Regression analyses were performed to show correlations. RESULTS We analyzed the responses of 729 patients and 702 sports medicine physicians. Most believed that telemedicine is useful. Physicians as well as patients rated their knowledge of telemedicine as unsatisfactory. The majority of respondents said they do not currently use telemedicine, although would like to do so. Patients and physicians reported that their attitude had changed positively towards telemedicine and that their usage had increased due to COVID-19. The majority in both groups agreed on implementing virtual visits in stable disease conditions. Telemedicine is considered to be helpful for follow-up monitoring and prevention by both groups. CONCLUSIONS Telemedicine in Sports medicine finds limited use but high acceptance among physicians and patients alike. The absence of a structured framework is an obstacle to effective implementation. Training courses should be introduced to improve the limited knowledge in the use of telemedicine. More research in tele-sportsmed is needed. These include large-scale randomized controlled trials, economic analyses and the exploration of user preferences.

scholarly journals Awareness of the role of general practitioners in primary care among outpatient populations: evidence from a cross-sectional survey of tertiary hospitals in China

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020605 ◽  
Author(s):  
Xiaojun Liu ◽  
Anran Tan ◽  
Samuel D Towne Jr ◽  
Zhaoxun Hou ◽  
Zongfu Mao
Keyword(s):  
Chronic Disease ◽  
General Practitioners ◽  
Public Awareness ◽  
Routine Care ◽  
Survey Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
The Status ◽  
Tertiary Hospitals

ObjectiveGeneral practitioners (GPs) are highly underutilised in China with many patients going directly to hospitals when seeking routine care. Multiple countries around the world have successfully used GPs in routine care, and as such, China may benefit from the use of GPs. This study examines the status of, and factors associated with, knowledge related to GPs among outpatient populations from China’s tertiary hospitals.DesignThis is a cross-sectional survey study.Study setting and participantsThe questionnaires were completed by 565 outpatients from four tertiary hospitals in China during 2016. Convenience sampling on different floors and throughout the outpatient building was carried out.Primary outcome measuresWe used the logistic regression models to identify GP-related knowledge among different populations.ResultsOverall, 50.27% of respondents said they had never heard of GPs. This was also true among females (adjusted OR (AOR)=1.57, 95% CI 1.43 to 2.71), older adults (AOR46–65=1.61, 95% CI 1.39 to 2.98; AOR>65=2.01, 95% CI 1.62 to 3.59), those with lower education level (AORBachelor’s degree=0.61, 95% CI 0.20 to 0.81; AOR≥Master’s degree=0.49, 95% CI 0.23 to 0.76), rural residents (AOR=1.51, 95% CI 1.35 to 2.82) and those with chronic disease (AORwithout chronic disease=0.61, 95% CI 0.22 to 0.71). What is more, less than one-in-ten (9.03%) outpatients were able to accurately describe what a GP was, with less than 30% accurately describing a GP among those receiving GPs’ services.ConclusionsOutpatients who could have received less costly health services from GPs in primary medical institutions were more likely to choose costlier specialist physicians in tertiary hospitals, which is likely linked to limited knowledge about GPs. Policy makers should invest in outreach efforts to improve public awareness of GPs, while at the same time conducting continued surveillance of these efforts to evaluate progress towards this goal.

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