Due to additional responsibilities and uncertainties during the COVID-19 pandemic, primary healthcare (PHC) workers are at increased risk of burnout.

To determine and compare the burnout levels and related factors in PHC nurses and family physicians (FPs) during the COVID-19 pandemic.

An online survey was delivered to PHC workers. Non-random sampling method was used. To evaluate burnout, the Maslach Burnout Inventory was used, which investigates burnout in three categories: emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). Multivariate linear regression was used to analyze factors associated with burnout for FPs and nurses separately.

Among the participants, 55.7% were nurses, the mean age was 42.34. FPs and nurses experienced similar levels of burnout in terms of EE. Family physicians had higher levels of low PA and DP. Based on the results of the multivariate analysis, while higher EE levels were significantly associated with unequal distribution of workload and communication problems within the Family Health Center for physicians, the unequal distribution of PPE, lack of appreciation by patients or colleagues and restrictions on work-related rights were relevant factors for nurses. Lack of appreciation and restrictions of the rights were associated with increased DP scores in both groups. Unequal distribution of workload was also associated with reduced PA among FPs.

PHC physicians and nurses are affected by burnout in different ways under the conditions of the COVID-19 pandemic based on gender, socioeconomic status and working conditions. To protect the mental health of PHC workers in the next public health emergency, clarification in the organization of services, empowering PHC workers in emergency risk communication and provision of timely, adequate and free PPE is essential. It is also crucial to ensure the rights of health workers through macro policy changes especially during emergencies.

In our country, there are childhood vaccinations that are not included in the routine vaccination schedule and that families have to buy and have for a fee. In addition to income level, family physicians’ recommendations also play a major role in getting these vaccines.

Our study was planned to determine the level of knowledge, attitudes and behaviors of family physicians about rotavirus, HPV and meningococcal vaccines, which are not included in the routine vaccination scheme of the Ministry of Health.

Our cross-sectional and descriptive study was carried out between May and July 2019. The population of our study consists of approximately 30 000 family physicians working as Family Physicians in Turkey. When the sample size is calculated with 5% margin of error and 95% confidence interval, it turns out to be 381. A 15-question questionnaire prepared by scanning the literature and including socio-demographic characteristics was presented to the participants. The Likert scale, which includes 12 questions about rotavirus, meningococcus, HPV and vaccines developed for these microorganisms, was administered to physicians either face-to-face or via the internet. In our study, the statistical significance level was accepted as P < 0.05, and the SPSS statistical package program was used in the calculations.

81 Research Assistants, 62 Family Medicine Specialists and 234 Family Physicians participated in our study, and the participants were determined by simple random sampling method. The mean age of the participating physicians was 37.96 ± 9.3 (min: 25 and max: 68). 50.9% of the physicians were women, 79.8% were married, 85.1% were in the city center, and 62.1% were practicing family medicine as general practitioners. 74.82% of the participating physicians recommend rotavirus and 56.2% HPV vaccines to their patients. 10.6% (40 people) of the physicians participating in our study did not recommend any of the rotavirus, HPV, meningococcal, influenza and adult pertussis vaccines to their patients. In the evaluation of the reason for this, 58.7% (27 people) of physicians who did not recommend special vaccines state that they did not recommend vaccines because they are not included in the routine vaccination schedule of the Ministry of Health. Another important reason was that the vaccines are paid (30.4%, 14 people). To the question of having sufficient information about special vaccines that are not included in the routine vaccination schedule, 26% of the participants stated that they have sufficient knowledge, and 56.5% stated that they have partial knowledge. The Likert knowledge questions total score of those who recommended at least one vaccine to their patients was significantly higher than those who did not recommend it at all. Likert knowledge questions total score of those who had at least one vaccination was significantly higher than those who never had it (P = 0.001).

In general, as the level of knowledge about private vaccines decreases, the rates of self-vaccination, recommending it to their patients, and asking it to be included in the national vaccine schedule decrease. For this reason, increasing the knowledge of physicians about vaccines not included in the national vaccination schedule will contribute to the dissemination of vaccines, thus increasing immunity and reducing mortality and morbidity.

We examined barriers and facilitators to patient-family physician discussions in Israel about advance care planning, including preparation of an advance directive by adults over age 65, as part of a program in two community health clinics which afforded family physicians the opportunity to dedicate time to such discussions with patients. To the best of our knowledge, the program is the first of its kind in Israel.

We used thematic analyses of qualitative data collected through 22 interviews with patients with pro-advanced care planning attitudes and three focus groups with eleven family physicians.

Overall, three themes in the interviews with patients and two themes in the focus groups with physicians emerged. The program gave people with pro-advanced care planning attitudes the opportunity to follow through with their ideas. We found that patients viewed their family physicians as facilitators and that the use of an information leaflet was an effective way to promote advance directives. Family physicians expressed positive attitudes toward assisting patients in the preparation of advance directives and welcomed an allotment of time for this endeavor as part of their schedule but expressed hesitation about assisting patients concerning legal and moral issues.

A pro-advanced care planning attitude is not enough for patients to complete the process of creating an advance directive; patients need active encouragement and intervention in order to turn their ideas into action. More patient and physician education are necessary to enable patients to protect their right to self-determination in end-of-life medical decision-making and to support physicians as facilitators of the process.

General Practitioners (GPs) are inevitably involved when disaster strikes their communities. Evidence of health care needs in disasters increasingly suggests benefits from greater involvement of GPs, and recent research has clarified key roles. Despite this, GPs continue to be disconnected from disaster health management (DHM) in most countries.

The aim of this study was to explore the perspectives of disaster management professionals in two countries, across a range of all-hazard disasters, regarding the roles and contributions of GPs to DHM, and to identify barriers to, and benefits of, more active engagement of GPs in disaster health care systems.

A qualitative research methodology using semi-structured interviews was conducted with a purposive sample of Disaster Managers (DMs) to explore their perspectives arising from experiences and observations of GPs during disasters from 2009 through 2016 in Australia or New Zealand. These involved all-hazard disasters including natural, man-made, and pandemic disasters. Responses were analyzed using thematic analysis.

These findings document support from DM participants for greater integration of GPs into DHM with New Zealand DMs reporting GPs as already a valuable integrated contributor. In contrast, Australian DMs reported barriers to inclusion that needed to be addressed before sustained integration could occur. The two most strongly expressed barriers were universally expressed by Australian DMs: (1) limited understanding of the work GPs undertake, restricting DMs’ ability to facilitate GP integration; and (2) DMs’ difficulty engaging with GPs as a single group. Other considerations included GPs’ limited DHM knowledge, limited preparedness, and their heightened vulnerability.

Strategies identified to facilitate greater integration of GPs into DHM where it is lacking, such as Australia, included enhanced communication, awareness, and understanding between GPs and DMs.

Experience from New Zealand shows systematic, sustained integration of GPs into DHM systems is achievable and valuable. Findings suggest key factors are collaboration between DMs and GPs at local, state, and national levels of DHM in planning and preparedness for the next disaster. A resilient health care system that maximizes capacity of all available local health resources in disasters and sustains them into the recovery should include General Practice.

The aim of this study was to describe the attitudes, views and solution proposals of family physicians (FPs) about primary healthcare problems of Syrian refugee patients. This study would be the very first study for Turkey that evaluates the attitudes, views and solution proposals of FPs about primary healthcare problems of Syrian refugee patients.

Following the anti-regime demonstrations that started in March 2011, the developments in Syria created one of the biggest humanitarian crises in the world and the largest number of asylum seekers continue to be hosted in Turkey. There are some studies evaluating asylum seekers’ access to healthcare services in Europe, and the common result is that refugees have free access to primary healthcare services in most countries; however, they face many obstacles when accessing primary healthcare services. While there are studies in the literature evaluating the situation of access to primary healthcare services from the perspective of asylum seekers; there are few studies evaluating the opinions/views of FPs.

A qualitative methodology informed by the grounded theory was used to guide the research. A total of 20 FPs were interviewed face to face through semi-structured interviews, using 12 questions about their lived experience and views caring of refugee population. Interviews were analysed thematically.

The following themes were revealed: Benefiting from Primary Health Care Services, Benefiting from Rights, Differences Between the Approach/Attitudes of Turkish Citizens and Refugees, Barriers to Healthcare Delivery, Training Needs of Physicians, Solution proposals. FPs reported that there is a need for support in primary care and a need for training them and refugees in this regard and they specified refugee healthcare centres are the best healthcare centres for refugees; however, the number of these and provided services should be increased.

Belgium has a problem with inappropriate use of emergency services. The government installed the number 1733 for out-of-hours care. Through a dry run test, we learned that 30% of all calls were allocated to the protocol ‘unclear problem’. In only 11.9% of all cases, there was an unclear problem.

The study aimed to determine whether the adjusted protocol ‘unwell for no clear reason’ led to a safer and more efficient referral and to evaluate the efficiency and safety of the primary care protocols (PCPs). The study ran in cross-sectional design involving patients, General Practitioner Cooperatives and telephone operators. A random sample of calls to 1733 and patient referrals were assessed on efficiency and safety.

During 6 months in 2018, 11 622 calls to 1733 were registered. Seven hundred fifty-six of them were allocated to ‘unwell for no clear reason’, and a random sample of 180 calls was audited. To evaluate the PCPs, 202 calls were audited. The efficiency and safety of the protocol ‘unwell for no clear reason’ improved, and safety levels for under- and over-triage were not exceeded. The GP’s judged that 9/10 of all patient encounters were correctly referred.

This study demonstrated that the 1733-telephone triage system for out-of-hours care is successful if protocols, flow charts and emergency levels are well defined, monitored and operators are trained.

To develop the Primary care fUnctions oF Family physicians in Childhood Asthma (PUFFinCA) scale for evaluating the cardinal process functions of primary care services (accessibility, comprehensiveness, continuity and coordination) provided by family physicians (FPs) in the management of childhood asthma.

In the literature on the functions of primary care, there is no assessment tool focusing on children with asthma. Primary care assessment scales adapted to various languages are not suitable to adequately address the needs of special patient groups, such as children with asthma.

In this methodological study, the instrument development process was completed in four stages: establishing the pool of items, evaluating the content validity, applying the scale and statistical analysis. The scale was applied to 320 children who had asthma and received care in the clinic of the Department of Pediatrics, Division of Allergy and Pulmonology at Ege University School of Medicine, Turkey. The Cronbach’s α and Spearman–Brown coefficient were calculated to determine the reliability of the scale. Principal component analysis was used to determine the construct validity of the scale.

The PUFFinCA scale was found to have four-factor structure and 25 items. Cronbach’s α coefficient was 0.93. It has been determined that the reliability was excellent and the item-total correlation coefficients were >0.30 each. The factors were titled FP’s ‘functions of accessibility, first contact and continuity’, ‘functions of coordination and comprehensiveness of health services related to asthma management’, ‘provision of preventive care related to asthma’ and ‘provision of services for paid vaccinations’.

This study investigates the knowledge, attitudes, and practices (KAP) of family physicians in Iran, regarding osteoporosis and their experience with national osteoporosis guideline.

Osteoporosis is a relatively preventable, chronic and progressive disease. Family physicians play a crucial role in relieving the burden of care.

This cross-sectional study was addressed at all qualified family physicians who registered at urban family physicians and referral system program. Data collection included demographics, professional experience, and knowledge of guidelines based on a standardized KAP questionnaire. Student’s t-test was used to measure the associations between KAP scores and demographic, professional experience variables.

The response rate was 72% (540/750). Based on Bloom’s cut off scale, family physicians knowledge and practice scores were in moderate level, and only 14 and 38.5% of them had good knowledge and practice, respectively. Attitude score was in good level, and 64.1% of participants had positive attitude. Mean score of knowledge and practice were higher significantly among family physicians that practice in public settings. Family physicians, who completed osteoporosis training courses, had higher attitude score (P=0.03). Only 23.5% of family physicians were aware of the existence of national osteoporosis guideline.

Although most family physicians believed in the importance of preventive measures, however, limited number of them had good knowledge and practice regarding osteoporosis and less than a quarter were aware of national guideline. This is a clear need to disseminate the guideline more effectively, make greater use of efficient training methods.

This study aims to assess the knowledge, attitude and practice of primary care physicians (PCPs) in Lebanon regarding nutrition counseling and to investigate possible related barriers.

Nutrition counseling is an important aspect of patient care, especially with the increase in nutrition-related disorders.

This is a descriptive study among a convenience sample of PCPs in Lebanon at two annual conferences in 2014 using an anonymous questionnaire.

Response rate was 54.6%. Overall, physicians considered that they have good to very good nutritional knowledge. Although they rated their formal nutritional education poorly, they had a positive attitude towards nutritional counseling and reported practicing general nutritional counseling with their patients. Barriers to nutritional counseling were: time, perceived poor patient adherence to diet, gap in physician’s nutritional knowledge and lack of insurance coverage for dietitian fees. Changes should be made to medical education curricula to include nutrition courses related to prevalent health problems.

Health care systems are changing around the world; family doctors need to adapt and prepare for future challenges.

To consider the present status of family doctors, anticipated changes in health care systems, the challenges these will bring and possible solutions.

Collaborative enquiry amongst members of the International Federation for Primary Care Research Networks (IFPCRN). Six strategic questions were addressed by 37 contributors from 23 countries. Responses were collated and contributors invited to further comment on the interim report.

Present status: Despite wide variability, common problems relate to delivery systems, funding and policy, lack of evidence-based medical practice, education and research. Role of family doctors: There is wide variability in roles and often poor interaction with other caregivers. Anticipated changes: An expansion of the family physician model is anticipated, alongside shortages of family doctors in the face of increased health care needs, increased complexity of problems and the shift to ambulatory care. Advances in information technology may be useful. Anticipated challenges and proposed actions: Address quality issues. This requires audit and quality assurance, promoting adaptability, promoting group practices and teamwork, coordinating care, incorporating information technology and ensuring ethical relationships with industry. Improve education and continuing professional development: Improved education and continuing professional development are needed, as are measures to prevent burnout and retain the workforce. Develop a robust research enterprise: Research in primary care is needed to develop relevant guidelines. Improve support for family doctors: Providing excellent patient care is essential for improved status and support. Achieving this requires engagement with policy makers, academic institutions and the public.

While there is great variability across different countries, common themes relate to present status, anticipated changes in health systems and the responses needed from family medicine.

To determine the effectiveness and safety of procedural sedation and analgesia (PSA) in a Canadian community emergency department (ED) staffed primarily by family physicians and to assess the role of capnometry monitoring in PSA.

One hundred and sixty (160) consecutive procedural sedation cases were reviewed from the ED of a rural hospital in Huntsville, Ont. The ED is mainly staffed by family physicians who have received in-house training in PSA. Safety and effectiveness measures were extrapolated from a standardized PSA form by a blinded research assistant.

The mean age of the patient population was 33.6 years (standard deviation = 23.6). Fifty-four percent of the patients were male, and 33% of the cases were pediatric. PSA medications included propofol (84%), fentanyl (51%) and midazolam (15%), and the procedural success rate was 95.6%. The adverse event (AE) rate was 18% and included apnea (10%), inadequate sedation (3%), bradycardia (2%), desaturation (1%), hypotension (1%) and bag-valve-mask use (1%). In those aged ≥65 years there was a greater incidence of apnea. There were no episodes of emesis and there were no intubations. A modified jaw thrust manoeuvre was used in 23% of the cases. In the 64% of cases where capnometry was used, there was no association between its use and any AE measures.

Procedural sedation was safe and effective in our environment. Capnometry recording did not appear to alter outcomes, although the data are incomplete.