BackgroundDepression constitutes a significant part of the global burden of diseases. General practice plays a central role in diagnosing and monitoring depression. A telemedicine solution comprising a web-based psychometric tool may reduce number of visits to general practice and increase patient empowerment. However, the current use of telemedicine solutions in the field of general practice is limited. This study aims to explore barriers and facilitators to using a web-based version of the Major Depression Inventory (eMDI) for psychometric testing of potentially depressive patients in general practice.MethodsSemi-structured individual interviews were conducted with nine general practitioners (GPs) from eight general practices in the Central Denmark Region. All interviewees had previous experience in using the eMDI in general practice. Determinants for using the eMDI were identified in relation to the GPs’ capability, opportunity and motivation to change clinical behaviour (the COM-B system).ResultsOur results indicate that the main barriers for using the eMDI are related to limitations in the GPs’ opportunity in regards to having the time it takes to introduce change. Further, the use of the eMDI seems to be hampered by the time-consuming login process. Facilitating factors included behavioural aspects of capability, opportunity and motivation. The implementation of the eMDI was facilitated by the interviewees’ previous familiarity with the paper-based version of the tool. Continued use of the eMDI was facilitated by a time-saving documentation process and motivational factors associated with clinical core values. These factors included perceptions of improved consultation quality and services for patients, improved possibilities for GPs to prioritise their patients and improved possibilities for disease monitoring. Furthermore, the flexible nature of the eMDI allowed the GPs to use the paper-based MDI for patients whom the eMDI was not considered appropriate.ConclusionsImplementation of a telemedicine intervention in general practice can be facilitated by resemblance between the intervention and already existing tools as well as the perception among GPs that the intervention is time-saving and improves quality of care for the patients.

ObjectiveTo assess general practitioners’ (GPs’) information-seeking behaviour and perceived importance of sources of scientific medical information and to investigate associations with GP characteristics.DesignA national cross-sectional survey was distributed electronically in December 2013.SettingDanish general practice.SubjectsA population of 3440 GPs (corresponding to approximately 96% of all Danish GPs).Main outcome measuresGPs’ use and perceived importance of information sources. Multilevel mixed-effects logit models were used to investigate associations with GP characteristics after adjusting for relevant covariates.ResultsA total of 1580 GPs (46.4%) responded to the questionnaire. GPs’ information-seeking behaviour is associated with gender, age and practice form. Single-handed GPs use their colleagues as an information source significantly less than GPs working in partnership practices and they do not use other sources more frequently. Compared with their younger colleagues, GPs aged above 44 years are less likely to seek information from colleagues, guidelines and websites, but more likely to seek information from medical journals. Male and female GPs seek information equally frequently. However, whereas male GPs are more likely than female GPs to find that pharmaceutical sales representative and non-refundable CME meetings are important, they are less likely to find that colleagues, refundable CME meetings, guidelines and websites are important.ConclusionResults from this study indicate that GP characteristics should be taken into consideration when disseminating scientific medical information, to ensure that patients receive medically updated, high-quality care. KEY POINTSResearch indicates that information-seeking behaviour is associated with GP characteristics. Further insights could provide opportunities for targeting information dissemination strategies.Single-handed GPs seek information from colleagues less frequently than GPs in partnerships and do not use other sources more frequently.GPs aged above 44 years do not seek information as frequently as their younger colleagues and prefer other information sources.Male and female GPs seek information equally frequently, but do not consider information sources equally important in keeping medically updated.

BackgroundGiven uncertainty surrounding benefits and harms, shifts in patient health status, and changing patient goals and preferences, statin deprescribing may be considered in some older people. This decision should be carefully discussed between GPs and patients.AimTo explore how GPs discuss deprescribing of statins with their older patients.Design & settingA qualitative study was undertaken using face-to-face, semi-structured interviews with Danish GPs from the regions of Southern Demark and Zealand.MethodThe GP participants belonged to group practices and were identified from personal networks and snowballing. The interviews lasted approximately 30 minutes and were conducted in English. They were analysed using systematic text condensation.ResultsA total of 11 GPs were interviewed and three themes were identified. (1) Reason for initiating a discussion: statin deprescribing mainly came up when GPs reviewed medication lists. There were differences between GPs regarding when or if they brought up deprescribing. (2) Discussion topics: GPs often discussed their interpretation of evidence surrounding statin use in older people. There were differences in how and if GPs discussed patient preferences. GPs viewed uncertainty and life expectancy as difficult to discuss. (3) Depth of discussion: the perceived level of patient engagement, and clinical context, could influence the extent of discussion.ConclusionGPs identified a range of topics that could be discussed with patients surrounding statin deprescribing. The depth and content of discussions varied according to the situation, and between GPs. Challenges may exist in communicating around certain topics, such as uncertainty and life expectancy. Further understanding of how to best communicate around challenging topics, and development of structured frameworks, may help facilitate statin deprescribing discussions. Identifying what patients think is important to discuss would provide necessary insight to promote quality discussions and shared understanding of the decision.

BackgroundIt has for years been discussed whether practice staff should be involved in patient care in general practice to a higher extent. The research concerning task delegation within general practice is generally increasing, but the literature focusing on its influence on general practitioners' and their staff’s job satisfaction appears to be sparse even though job satisfaction is acknowledged as an important factor associated with both patient satisfaction and medical quality of care. Therefore, the overall aim of this study was 1) to review the current research on the relation between task delegation and general practitioners' and their staff’s job satisfaction and, additionally, 2) to review the evidence of possible explanations for this relation.MethodsA systematic literature review. We searched the four databases PubMed, Cinahl, Embase, and Scopus systematically. The immediate relevance of the retrieved articles was evaluated by title and abstract by the first author, and papers that seemed to meet the aim of the review were then fully read by first author and last author independently judging the eligibility of content.ResultsWe included four studies in the review. They explored views and attitudes of the staff, encompassing nurses as well as practice managers. Only one of the included studies also explored general practitioners' views and attitudes, hence making it impossible to establish any syntheses on this relation. According to the studies, the staff’s overall attitude towards task delegation was positive and led to increased job satisfaction, probably because task delegation comprised a high degree of work autonomy.ConclusionsThe few studies included in our review suggest that task delegation within general practice may be seen by the staff as an overall positive issue contributing to their job satisfaction, primarily due to perceived autonomy in the work. However, because of the small sample size comprising only qualitative studies, and due to the heterogeneity of these studies, we cannot draw unambiguous conclusions although we point towards tendencies.