搜索结果：The European journal of general practice

Female general practitioners (GPs) often encounter diverse challenges in sustaining a career in general practice, in addition to those experienced by their male counterparts, which may have implications for workforce planning and retention in Ireland. To explore the experiences and expectations of female GPs regarding a sustainable career in general practice. Rooted in a constructivist paradigm, this qualitative study was conducted in Ireland. Thirteen online semi-structured interviews were conducted using 'Love and Breakup Letter' methodology as an elicitation prompt to facilitate discussion. Narratives were explored thematically. Participants viewed their GP role as an integral part of their identity. A career in general practice was found to be fulfilling, with a constant stream of new learning opportunities. The unique context of establishing long-term relationships with patients and having a supportive peer network was the primary motivation for pursuing and staying in this career. Yet, despite these benefits, dissatisfaction with the primary care system, competing family responsibilities and gender-driven challenges added further complexity to sustaining their careers. The incompatibility between work and family life has led many to adapt their careers, reducing clinical hours and pursuing diverse GP careers, to regain balance and manage competing demands. The career of a GP was treasured among women who chose this profession; however, system changes are needed to ensure the ideals of sustained and satisfying GP careers are upheld. Equipping GP graduates with skills to diversify their careers and promoting a strong peer-support network and mentoring opportunities are recommended. Female GPs in Ireland face ongoing challenges, including systemic pressures, work-life difficulties and gender related barriers.Flexible career pathways, including reduced hours and diversified roles, may support sustainability and focused patient care.Establishment of policies promoting career development, collegial workplace culture and family-friendly practice models is needed to support female GPs.

In the Netherlands and Germany, most antibiotics are prescribed in primary care, with urinary tract infections (UTIs) being the most common reason. The resistance rates of pathogens causing UTIs are rising in Europe. Differences in clinical practice guidelines may play a role and influence the prevalence of antibiotic resistance and treatment options. Therefore, we aim to explore the reality of general practices, including the diagnosis and management of uncomplicated UTIs in the Northern Dutch-German cross-border region. From January 2023 to April 2024, a qualitative study was performed using semi-structured interviews with German and Dutch general practitioners (GPs). The number of interviews was determined when data saturation was reached. The interviews were recorded, transcribed, translated and anonymised. MAXQDA (Version 24.1.0.) was utilised to code the interviews. The analysis was done using structured qualitative content analysis. We recruited 13 GPs in Germany and 10 GPs in the Netherlands. Four main themes were identified: diagnosis, treatment options, decision making and guidelines. Dutch GPs delegated most diagnosis and treatment tasks to practice assistants, which is facilitated by the more stringent use of guidelines. More variety was seen in the types of antibiotics and herbal remedies used by German GPs. This study provides valuable insights into GPs' decision making regarding the diagnosis and treatment of UTI. Increasing awareness of UTI diagnosis and treatment can help GPs assess their own practices and think more critically of their antibiotic use. Further research is needed to explore the effects on antibiotic resistance in the cross-border region. Both German and Dutch GPs reported using dipsticks and medical history to diagnose UTI and using cultures in uncertain cases.Dutch GPs perceived following guidelines more than German GPs and delegated diagnosis and treatment tasks to assistants.German GPs reported more variety in antibiotics and herbal remedies.

Recent studies indicate that the synthetic thyroid hormone levothyroxine (LTX) in many cases has no beneficial effects on patients with subclinical hypothyroidism. Still, prescriptions are increasing worldwide. If there is no clear indication for treatment, patients treated with LTX should be offered a deprescribing trial according to current guidelines. However, there is currently no protocol for deprescribing LTX in primary care. We aimed to explore patients' enablers and barriers towards deprescribing levothyroxine in primary care to inform the further participatory development of a deprescribing strategy. Based on the COREQ checklist, focus group discussions were conducted with patients and general practitioners as well as patients only in 2024. Participants ranked the five most crucial enablers and barriers. Transcripts and prioritised elements were examined using the qualitative content analysis method according to Kuckartz. Patients frequently felt misinformed about their condition and the prescription of LTX. A change in their medications raised doubts and uncertainties. However, the potential advantages and opportunities of deprescribing were compelling: a (re)gain of quality of life, a decrease in probable drug side effects, savings of time and cost. Mostly, patients welcomed a gradual and managed deprescribing under their general practitioner's supervision. Patients wished for medical information to reduce their doubts concerning deprescribing and expressed confidence in their general practitioner. Our findings indicate a fundamental commitment to deprescribing LTX. For an adherent process in general practitioners' practices, a strategy that considers patients' worries and concerns seems feasible. Patients with subclinical hypothyroidism are open to having levothyroxine deprescribed if they are advised to do so by their general practitioner.Targeted medical information, a stepwise approach, and close supervision by their general practitioner were identified as enablers.

General practice medical records offer significant potential for secondary use in research, policy and public health. In Australia, these data remain underused due to concerns around privacy, governance and ethical use. Understanding the perspectives of GPs is essential to developing best practice recommendations for responsible data use. A three-round modified Delphi study was conducted with 22 Australian GPs with experience in research and/or data sharing. Participants rated and commented on 11 recommendations derived from community juries, with consensus defined as ≥75% agreement. Feedback summaries and thematic analysis informed subsequent rounds. Consensus was reached on 10 of 11 recommendations. The panel supported ethical approval, transparency, protection of the doctor-patient relationship and remuneration for practices contributing data. An opt-out approach to consent was endorsed under strict conditions, with clear distinctions made between vulnerable and non-vulnerable populations. The panel also supported the establishment of a governance body and researcher cybersecurity training. However, no consensus was reached on community involvement in research design, despite its growing recognition as best practice by funding bodies. This study highlights the need for a nationally agreed remuneration model for general practices that contribute data, clearer ethical guidance for engaging vulnerable populations and reform of statutory frameworks to support responsible data use. The lack of consensus on community involvement is concerning, especially as initiatives such as the Australian Institute of Health and Welfare (AIHW) and Primary Health Networks (PHN) partnership advance national data standards. Bridging this gap is essential to align professional practice with public expectations and ensure inclusive, ethically robust research. General Practitioners (GPs) support ethical, transparent general practice data use, with Human Research Ethics Committee (HREC) approval, governance, and cybersecurity safeguards. Remuneration and opt-out consent are endorsed, provided strict ethical conditions are met. Community involvement in research design remains contested, revealing a gap between public and practitioner views.

Overprescribing of short-acting beta-agonist (SABA) inhalers is a worldwide problem. To evaluate the impact of a system-wide quality improvement programme on SABA overprescribing, and to identify the most effective strategies. All general practices within one East London borough received the intervention between October 2020 and March 2023. Practices in two neighbouring boroughs acted as comparators. Intervention practices engaged in quality improvement activities including: electronic alerts flagging patients prescribed &#x2265;12 SABA inhalers/year; generating lists of patients overprescribed SABA to call for review; a summary guideline for clinicians; electronic patient information leaflets. All practices were offered webinar coaching. Prescribing data were collected from electronic health records, and SABA overprescription evaluated through interrupted times series analysis. Content analysis was applied to survey data and conversations with staff. During the three-year study period all localities introduced programmes to reduce SABA prescribing. We observed a significant decrease in the proportion of asthma patients prescribed more than 6 SABA/year in the study practices. The COVID pandemic triggered a temporary increase in patients on asthma registers, which persisted for 6&#x2009;months. When implemented by practices the electronic prescribing alerts were effective: 50% of patients who received an active response reduced to <12 SABA in the following year. This quality improvement programme was associated with a reduction in SABA overuse, which could also decrease hospital admissions. Practices required individual coaching to use the electronic tools effectively. Integrated prescribing alerts reduced overprescribing, and collaborative practice cultures supported faster implementation of improvement strategies. Using a learning health system built on electronic prescription data from primary care was associated with a reduction in short-acting beta-agonist (SABA) overprescribing.Prescribing alerts, integrated within the practice software, were associated with a reduction in overprescribing in the subsequent year.Localities which had a culture of general practices working together were able to implement quality improvement and other strategies more rapidly.

Healthcare demand in English general practice exceeds supply, necessitating practice efficiency. To our knowledge, no study has explored factors associated with practice efficiency in England using a quality-adjusted output. To determine practice-level efficiency in England and identify associated factors using a quality-adjusted output. We conducted a cross-sectional study using NHS datasets from 2023. Practice efficiency was determined by comparing input (measured using funding and workforce) with output (measured using clinical quality, patient experience, and service volume). Practices were classified as efficient (low input, high output), neutral (same input and output levels), or inefficient (high input, low output) using K-medoids clustering, a machine learning technique. Multivariable logistic regression was used to identify factors associated with practice efficiency (i.e. efficient or inefficient, excluding neutral). Of 5069 practices, 1117 were classified as efficient, 2773 as neutral, and 1179 as inefficient. Efficiency was lower in practices with a larger patient list (adjusted odds ratio 0.23, 95% CI 0.19-0.28), those with a higher percentage of patients with a chronic condition (0.47, 0.38-0.58) or patients &#x2265; 65&#x2009;years (0.63, 0.49-0.81), those in a higher deprivation area (0.25, 0.20-0.32), those that dispense medications (0.52, 0.37-0.73), and those with an alternative provider medical services (vs. general medical services) contract (0.15, 0.07-0.33). Efficiency was higher in urban practices (1.38, 1.00-1.90) and practices with a higher percentage of mixed (1.66, 1.24-2.21) or other ethnicity patients (1.78, 1.22-2.60). Smaller practices were more efficient. Therefore, policies that encourage practice mergers may not deliver the efficiency gains expected. In England, smaller general practices tend to be more efficient, optimising input and output more effectively than larger general practices.Policymakers should not assume that actions, such as general practice mergers, which typically generate economies of scale, will necessarily improve general practice efficiency.

Diagnostic prediction models are commonly used in general practice to support clinical decision-making. Traditionally, these models have been developed using statistical methods such as logistic regression. While these approaches have proven useful, they often produce average risk estimates that may not fully account for the complexity of individual patients. In recent years, the use of machine learning (ML), a subfield of artificial intelligence (AI), has grown in healthcare. We examine the similarities and differences between traditional statistical methods and AI/ML approaches for diagnostic prediction in general practice. Using examples from daily practice, we explore how ML techniques can add value, particularly in handling large, complex datasets such as those derived from electronic health records. We also discuss key challenges that hinder the adoption of AI/ML in general practice, including interpretability, data quality, external validation, clinical relevance, implementation and legal issues, and practical usability. We provide recommendations to overcome these challenges. The potential of AI/ML can only be realised if tools are developed collaboratively with GPs, focused on real-world clinical problems, and rigorously validated in practice settings. GP associations, GPs, patients, and primary care scientists should take an active role in the development, validation, and implementation of AI/ML-based diagnostic prediction tools for general practice.

Central and Eastern European (CEE) countries began healthcare reforms in the late twentieth century, adopting Family Medicine/General Practice (FM/GP) models. The FATMEE (Family Medicine After Transformation in Middle and Eastern Europe) study in 2012 found this process advanced but incomplete. This study (FATMEE-2) examines current FM/GP development in the CEE region that follows recent social changes and healthcare challenges. A mixed-methods approach combined literature and dataset review with a Key Informant-based survey using the updated FATMEE questionnaire, exploring the FM/GP role in primary care. FM/GP is recognised as a separate medical speciality in all countries with robust legal frameworks. Care comprehensiveness varies, with some systems maintaining separate paediatric and adult services, and a lack of gynaecology and obstetrics services in many. Weighted capitation remains the dominant funding model, supplemented by pay-for-performance and fee-for-service schemes. Electronic medical records and teleconsultations are common. Compared to the previous FATMEE study, changes include increased use of digital tools and diversified financing. Primary care structure and professional roles changed little. While the legal and technological foundations of family medicine in CEE countries have strengthened, comprehensiveness and service integration have limitations. There is a visible progress in infrastructure and digitalisation, but the structural and organisational challenges identified in 2012 largely remain. This may indicate that sustained political commitment and systemic reform - beyond legal acknowledgement and technological improvements - are essential for successful transformation. However, the examples of Estonia and Slovenia prove that under a supportive policy, such a transformation is achievable.

Prescribing epidemiology in general practice shows gabapentinoid drugs to be independently associated with unexpected, drug-related death. There is an increasing trend of gabapentinoid deaths throughout Europe and North America. The overall aim of this study was to assess how patient, practice and health system factors might be associated with gabapentinoid prescribing in primary care. Case series following a critical incident of an unexpected death in a patient prescribed a gabapentinoid drug in a single general practice. Unexpected and expected deaths in patients prescribed a gabapentinoid drug deaths over an 11-year period in a single general practice. We examined patient, prescriber and health system factors. Toxicology and post-mortem data were provided by the Coroner. There were 36 deaths (four unexpected and 32 expected deaths) during the study period. Of the four patients who suffered an unexpected death, one of these patients' cause of death could be attributed to drug and alcohol toxicity. Over half of gabapentinoid prescribing (n&#x2009;=&#x2009;19,53%) was hospital initiated, often 'off-label' (n&#x2009;=&#x2009;6, 17%) and commonly co-prescribed with opiates (n&#x2009;=&#x2009;15, 42%) and benzodiazepines (n&#x2009;=&#x2009;11, 31%) to patients with high multi-morbidity. Gabapentinoids are often initiated in the outpatient setting in clinically complex patients, often for 'off label' indications, with high polypharmacy. Patient, practice and health-system related factors need to be addressed in relation to gabapentinoid associated deaths and reflected in clinical practice guidelines. There is critical value in using toxicology reports from Coroner's offices in cases of unexplained gabapentinoid death in general practice.

General practitioners (GPs) face numerous challenges that can contribute to stress. Understanding these factors is crucial for developing interventions to support physician wellbeing and maintain high-quality care. The study aims to explore the factors associated with perceived stress among European GPs, including attitudes towards person-centred care (PCC), demographics, and professional characteristics. The PACE GP/FP study is an online, cross-sectional, multi-centred survey conducted in 24 European countries between November 2022 and January 2024. The survey tool included the Perceived Stress Scale (PSS), the Patient-Practitioner Orientation Scale (PPOS), and questions on GPs' demographics and practice characteristics. Linear mixed models analysed the relationship between these variables and perceived stress. In total, 3522 GPs were included in the analysis. The mean PSS score indicated moderate levels of stress. Female gender and younger age were associated with increased stress. Also, a higher number of daily patient contacts and a greater perceived responsibility for vulnerable patient populations (e.g. migrants, those with limited social support, or psychiatric vulnerabilities) were significantly associated with higher stress. A stronger patient-centred orientation was associated with lower perceived stress. The findings have implications for interventions to reduce GP stress, such as training programs promoting PCC, optimising patient contact rates, and providing targeted support for GPs caring for vulnerable patients. Further research is needed to explore these factors' complex interplay and impact on GP wellbeing.

Endometriosis is a chronic, systemic condition affecting 5-10% of individuals assigned female at birth. Due to its non-specific symptoms, diagnosis is often delayed. This study aims to explore diagnostic challenges and decision-making processes that general practitioners (GPs) encounter when managing patients with symptoms suggestive of endometriosis in Denmark. A qualitative research approach was employed, incorporating the co-production of three fictional clinical vignettes representing diverse endometriosis presentations. Semi-structured interviews were conducted with 27 practicing GPs (7 males and 20 females) from urban and rural areas. Participants had a mean age of 50&#x2009;years (range 41-66) and clinical experience ranging from newly qualified to 27&#x2009;years. Interviews involved engagement with the vignettes, and data were analysed using thematic analysis. Findings reveal the challenge of the non-specific nature of symptoms, the role of cyclical symptom patterns in diagnosis, the influence of diagnostic hierarchies, patient-centred care approaches, the bio-psycho-social perspective in management, the persistent stigma surrounding gynaecological symptoms, and GPs limited trust in general gynaecologists. GPs were more likely to suspect endometriosis when symptoms followed a cyclical pattern, whereas gastrointestinal presentations were less commonly linked to the condition. While many GPs adopted a patient-centred, shared decision-making approach, some still adhered to mind-body dualism in their clinical reasoning. Diagnosing endometriosis in primary care is challenging due to non-specific symptoms, diagnostic hierarchies, and stigma. Encouraging GPs to routinely inquire about the cyclical nature of symptoms may serve as a valuable diagnostic tool, particularly in cases involving gastrointestinal complaints.

Breast cancer is the commonest cancer in women, and screening can allow earlier-stage diagnosis. While there are European recommendations on the age-range and frequency of breast cancer screening, participation in these programmes varies substantially, and this could be due to differences in how they are organised and implemented. The role that primary healthcare professionals play in the process is unclear.We aimed to describe the breast cancer screening programmes in European countries and investigate how primary healthcare professionals are involved in this screening process. A cross-sectional survey in 32 countries. Key informants with relevant expertise answered online questions about the characteristics of their screening programmes and general practitioners' (GPs') roles in this. Responses were refined through an iterative consensus process. Data were examined to identify patterns in GP engagement. We found important differences between European breast cancer screening systems. While most had population-based screening, four countries relied on opportunistic screening. In 15 countries GPs had little or no involvement in the process of breast cancer screening, and in 13 countries GPs had some involvement, including identifying eligible patients, issuing referrals, and following-up results. Screening uptake rates tended to be higher in countries with well-established population-based screening programmes which give little or no GP involvement. Few countries linked GP engagement to incentives or performance measures. Countries with lower screening uptake should consider either enhancing GP involvement or transitioning to a structured, population-based screening system. Further research should explore how best to integrate primary care within national screening strategies. Most European countries rely on population-based breast cancer screening.Screening uptake rates are higher in countries with well-established population-based screening programmes which give little or no GP involvement.Countries with lower screening uptake should consider transitioning to a structured, population-based screening system.

In Flanders, Belgium, the 3-year specialised training in General Practice includes a specialty training rotation, for which trainees may choose their training site. After graduation, General Practitioners (GPs) decide where to establish their practice. This study explored the factors influencing GP trainees' choice of training location, reasons for settling in a specific region after graduation, and motivations for remaining in or leaving a practice. In May 2024, the Interuniversity Centre for Education of General Practitioners distributed an anonymous online survey with closed- and open-ended questions to all GP alumni graduating between 2014 and 2023. Quantitative data were analysed using linear regression; qualitative data underwent content analysis. Of 772 alumni respondents (26.7% response rate), 93.4% were still practising as a GP. Most were female (70.9%), and 37.2% engaged in additional professional roles. Key influences on training location choice and practice settlement included colleague connections, proximity to home, and opportunities to work in group practices. Decisions to stay in or leave a practice were shaped by interpersonal relationships, practice organisation, and work-life balance. Working as a substitute GP was a frequent reason for changing practices, especially among recent graduates, to explore varied working environments. Both interpersonal and logistical factors strongly influence training practice choice and later GP practice settlement. High-quality training practices and supportive work environments are essential to promote sustainable GP careers and achieve a more balanced geographical distribution of GPs. GP trainees prioritise proximity to their family and interpersonal relations when selecting training location.Workplace relationships, practice organisation, and work-life balance are key determinants for joining and remaining in a GP practiceGP career strategies should extend beyond financial incentives, emphasising quality training practices, good GP practice organisation and positive team dynamics.

Background: Point-of-care ultrasound (POCUS) is an increasingly valuable tool in general practice/family medicine (GP/FM). This position paper from the European Academy of Teachers in General Practice/Family Medicine outlines recommendations for integrating POCUS education across the continuum of training: undergraduate, specialty, and continuing medical education. Recommendations: POCUS should complement, not replace, the clinical examination. Key priorities include GP/FM-targeted curriculum development, early exposure during basic medical education, mandatory residency training, context-sensitive continuing professional development, train-the-trainer programmes, and GP/FM-led implementation. Discussion: Integrating POCUS teaching across all stages of GP/FM education may support effective and sustainable adoption in primary care. Educational strategies should be adapted to local contexts and healthcare systems while maintaining a focus on clinically relevant and evidence-informed use. Conclusion: EURACT recommends the longitudinal integration of POCUS education throughout GP/FM training and professional development. These principles aim to guide the effective, sustainable, and context-sensitive implementation of POCUS in primary care. POCUS teaching in GP/FM should be integrated across basic medical education, specialty training, and continuing professional development.GP/FM targeted curriculum development, early exposure, and training during residency are essential for effective adoption.Context-sensitive continuing education and train-the-trainer programs support sustainable implementation.

The ageing population in Europe, particularly in rural areas, creates new health challenges, including patients with multiple comorbidities and difficult access to care. Advanced Practice Nurses (APNs) could play a key role in improving access and care for frail older patients in France's rural areas, although how to achieve this remains unclear. This study aimed to identify the healthcare needs of frail patients living at home in rural areas and those of their healthcare providers to assess the potential role of APNs in addressing these needs. This interpretive descriptive qualitative study was conducted from June to September 2023, using focus groups (FGs). Three FGs with 20 participants, including healthcare providers and frail older people, were conducted in two French rural areas. Data were analysed using thematic analyse to identify key needs and potential APN contributions. The healthcare needs identified were: improving access to care, maintaining human interactions, and providing coordinated, preventive care. Participants emphasised the importance of interprofessional collaboration and the central role of APNs, whose expanded skillset enables them to coordinate care with caregivers and professionals. However, challenges remain, including a lack of understanding of the APN's skills and concerns about their integration within the care team. APNs could support access to person-centred, coordinated home care in rural areas by acting as key references for patients, caregivers, and teams. However, limited awareness of their role and concerns from other professionals remain barriers to their integration. Frail older adults in rural areas need better access to home care, social connection, and coordinated services.APNs can enhance care and collaboration through advanced skills, addressing rural healthcare challenges.Limited awareness of APN roles hinders integration, making education essential for their acceptance and effective use.

Continuity of care (COC) is a core value in general practice. It has been deteriorating in Finnish primary health care, but there are now attempts to improve it. This study focused on gathering insights of primary care physicians (PCPs) on how COC can be improved within Finnish primary health care. We conducted a nationwide survey targeting all PCPs working in primary health care. A web-based questionnaire was sent to PCPs in Finland from May to October of 2023. The questionnaire included the question 'How would you improve continuity of care in your workplace?' Data were analysed using a descriptive approach that involved iterative and inductive thematic analysis. We received a total of 291 responses from PCPs across Finland (7% response rate). We identified themes related to organisation (e.g. arrangement of practical work including the size of a health centre), practice-level (e.g. autonomy, including the opportunity to perform COC in daily work), and themes related to digital solutions (e.g. data of COC measured and available). PCPs had considerable insight into the development of COC in day-to-day operations. Enhancing COC for a primary care patient population requires a systemic perspective and structured, goal-oriented development efforts. However, small and discrete steps can also contribute to improving COC for individual patients. Our findings highlight the link between COC enhancement and the development of the health care system as a whole. Improving continuity of care is closely linked to the overall development of the health care systemThis study proposes organisational, practice-level, and digital strategies to improve continuity of carePrimary care physicians can contribute significantly, drawing on their clinical experience and systemic understanding of health care.

Rural populations in Europe face health inequalities due to a multitude of factors, including the higher prevalence of multi-morbidity, inadequate access to primary and secondary health care services, and widespread health workforce shortages. Although some challenges are also present in other contexts, the multitude and interconnectedness of these factors induce significant health inequalities. Research is a prime tool to demonstrate these, examine potential rural-specific solutions and serve as an essential advocacy instrument for change. Rural primary care remains however significantly underrepresented in European research, contributing further to the health inequities as policies and interventions are often based on urban-centric data. Therefore, advancing evidence-based solutions for rural primary healthcare requires stronger research collaboration. In response, the Rural Health European Academic Network (RHEAN) was established in 2024 to expand academic partnerships beyond the WONCA Europe network EURIPA, the European Rural and Isolated Practitioners Association. This paper identifies rural-specific primary care challenges emerging from key literature and network discussions that shape RHEAN's collaborative research agenda. The agenda will be refined through a mapping survey of rural primary healthcare research and education within the networks. Published research on rural primary care across Europe is scarce, which has led to a limited evidence base for bespoke clinical interventions, health service design, funding, healthcare educational frameworks, and workforce planning.A European network of researchers and academic institutions has been established to address this gap through collaboration and priority setting.

Pharmaceuticals represent a major source of carbon emissions in primary care. General practitioners could avoid prescribing climate-harmful medications and consider eco-friendly alternatives in shared decision-making processes. However, evidence on patients' perceptions of discussing medication-specific environmental impacts in primary care consultations in Germany remains limited. To explore patients' perceptions of discussing medications' environmental and climate impact during family medicine encounters and their willingness to switch to more eco-friendly options. This qualitative study employed semi-structured interviews with patients recruited through GP practices in Northern Germany. Inclusion criteria were long-term use of at least one medication, legal age, and informed consent. Twenty-five interviews were conducted and analysed using structured content analysis according to Kuckartz. Respondents expressed surprise when environment/climate topics were to be discussed in medical encounters but demonstrated openness to these topics and desired more information about their medications' environmental impact. Many interviewees showed willingness to switch to eco-friendly medications despite potential disadvantages including more frequent intake, increased side effect risk, or co-payments. Patients exhibited high trust in provider recommendations and sought greater information and transparency. Results suggest opportunities to incorporate climate/environmental aspects into shared decision-making. Understanding patient perspectives enables GPs to address environmental/climate-friendly medication topics in treatment discussions. Patients are receptive to these discussions and willing to accept eco-friendly alternatives despite potential drawbacks. The high level of trust in provider recommendations positions family physicians as key actors in promoting environmental stewardship. Patients are open to discussing environmental and climate issues with their GPs.Patients trust medical recommendations and are willing to switch to more environmental/climate-friendly medications.Routine visits are particularly suitable for such discussions.Clear communication and accompanying materials are crucial.

While several risk scores for the diagnosis of community-acquired pneumonia (CAP) have been developed, they require prospective external validation. To externally validate existing prediction models, risk scores, and heuristics for the diagnosis of CAP in adults. The Enhancing Antibiotic Stewardship in Primary Care (EAST-PC) study recorded signs, symptoms, demographics, and vitals in 718 adults presenting to primary or urgent care clinics with acute lower respiratory tract infection between 2019 and 2023. C-reactive protein (CRP) was available for 575. The diagnosis of CAP was based on the clinician diagnosis and/or chest radiograph. Literature was searched for previous risk scores. Using the EAST-PC population, the area under the receiver operating characteristic curve (AUROCC), calibration curves, and percentage with CAP in each risk group were calculated for each risk score. We identified 11 studies describing 4 risk scores, 9 multivariate models, and 5 simple heuristics. The Genomics to Combat Resistance Against Antibiotics in Community-acquired LRTI in Europe (GRACE) risk score using the absence of a runny nose, the presence of breathlessness, crackles, diminished vesicular breathing, heart rate > 100/min, temperature >37.8&#x2009;&#xb0;C, and CRP > 30&#x2009;mg/L was the most accurate (AUROCC 0.81). It classified 280 patients as low (0.7% CAP), 265 as moderate (5.7%) and 30 as high risk (33.3%) for CAP. The GRACE score without CRP performed similarly. Other risk scores had poor calibration or failed to accurately classify patients as low or high risk. The previously derived GRACE risk scores were successfully externally validated in a contemporary US outpatient population. Two risk scores using clinical exam findings (with and without CRP) had acceptable accuracy for the diagnosis of community-acquired pneumonia (CAP).Their use classifies about half of patients with lower respiratory tract infections as very low risk for CAPFurther validation studies would be desirable in primary care settings.