Literature Collection

BACKGROUND: In Belgium, the incidence of treatment episodes for substance use problems is monitored by the Network of Sentinel General Practices (SGP), and at higher, specialist care levels by the Treatment Demand Indicator (TDI) surveillance. Using both data sources, we examine 1) how patients starting specialist treatment for substance use problems on referral by their GP compare to those that were referred by non-GP caregivers; 2) how patients starting GP treatment for substance use problems without receiving concurrent specialist treatment compare to those who did. METHODS: Both surveillances are based on the TDI protocol for reporting data to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) on individuals starting treatment as a result of their substance use. Data from 2016 and 2017 were examined using 95% confidence intervals and multivariate logistic regression. RESULTS: According to TDI-data (n = 16,543), determinants of being referred by a GP (versus by a non-GP caregiver) for specialist treatment were age ≥ median (OR 1.25; 95% CI 1.13-1.38), education ≥ secondary level (OR 1.27; 95% CI 1.15-1.41), recent employment (OR 1.71; 1.56-1.88), recent stable accommodation (3.62; 95% CI 3.08-4.26), first treatment episode (OR 1.72; 95% CI 1.57-1.87), recent daily primary substance use (OR 1.46; 95% CI 1.33-1.59) and mono substance use (OR 1.23; 95% CI 1.04-1.48). Type of substance use was a significant determinant with higher odds of using pharmaceuticals (and alcohol) (OR 1.24; 95% CI 1.04-1.48), and lower odds of using cannabis only/primarily (OR 0.73; 95% CI 0.62-0.86), with reference to street drugs minus cannabis only/primarily. According to SGP data (n = 314), determinants of starting GP treatment without concurrent specialist treatment were recent employment (OR 2.58; 95% CI 1.36-4.91), first treatment episode (OR 2.78; 95% CI 1.39-5.55) and living in the Brussels or Walloon region (OR 1.97; 95% CI 1.06-3.66). CONCLUSIONS: This study provides a useful insight into the general practice population treated for substance use problems. It shows that both surveillances consistently found a relatively favourable profile of general practice patients with substance use problems.

Phenomenon: There is a paucity of research reporting the experiences of general practitioner clinical educators. Providing education for students could lead to better clinical skills and greater job satisfaction for the educator. However, it could also result in increased stress and mental fatigue, adding to what is an already pressured situation in the current primary care climate. Clinical Debrief is a model of case-based learning with integrated supervision developed to prepare medical students for clinical practice. This study aimed to explore the experiences of general practitioners who facilitate Clinical Debrief. Approach: Eight general practitioner educators with experience of facilitating Clinical Debrief participated in semi-structured qualitative interviews. Results were analyzed using Reflexive Thematic Analysis, and four main themes were developed. Findings: Themes included: Personal enrichment: psychological "respite" and wellbeing; Professional enrichment: Clinical Debrief as a "two-way" door; Becoming a facilitator: a journey; and, Relationships in teaching: blurred boundaries and multiple roles. Insights: Being a Clinical Debrief facilitator had a transformative impact on the personal and professional lives of the GPs who participated in this study. The implications of these findings for individual GPs, their patients, and the wider healthcare system, are discussed.

BACKGROUND AND AIMS: For achieving an effective integrated primary health care, communication between healthcare providers is a key element. This study aimed to identify general practitioners' reported barriers to communication within referral systems and propose actionable strategies for improvement. METHODS: Guided by PRISMA 2020 guidelines, 22 qualitative studies from PubMed, Web of Science, Scopus, and ProQuest were analyzed using inductive thematic synthesis. Quality assessment followed Standards for Reporting Qualitative Research (SRQR) criteria. RESULTS: Four central themes emerged: structural barriers (subthemes: inefficient health system, shortages in the number of specialists and heavy workload), regulatory and procedural barriers (subthemes: lack of comprehensive communication protocols, unclear delineation of roles and responsibilities, inadequate economic incentives, lack of continuity between providers, lack of interest in specialists, time consuming communication process), technological barriers (subthemes: ineffective methods for communication, challenges in using electronic medical records), and personal and interpersonal barriers (subthemes: having different approaches to healthcare, inappropriate specialists' perceptions of general practitioners' roles, lack of professional trust and respect, social anxiety disorder in the workplace). CONCLUSION: Health policymakers must prioritize structural and procedural reforms, including standardized communication frameworks, interoperable digital infrastructure, and interprofessional training programs. Addressing these gaps can enhance referral system efficiency, reduce diagnostic delays, and strengthen health system resilience, particularly in low-resource settings. TRIAL REGISTRATION: The protocol of the review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on December 20, 2023 (Supporting Information S1).

BACKGROUND: Suicide is a major public health issue. Up to a third of patients will visit their General Practitioner (GP) in the month leading up to a suicide attempt, thus highlighting the key role GPs play in suicide prevention. AIM: This systematic scoping review aimed to explore the qualitative research on GPs' perspectives of suicide prevention in primary care. DESIGN & SETTING: A systematic scoping review of qualitative studies relating to the research question. METHOD: This review is reported in accordance with PRISMA-ScR guidance. Articles at full-text review were assessed for inclusion in the study against eligibility criteria (english language, qualitative research, focus on GPs perspectives of suicide prevention). Data were extracted using a standardised form and a thematic synthesis approach was used to describe the themes elicited from the studies. RESULTS: 2210 abstracts were screened. Twelve studies from seven countries were included at full text review. Four main themes were elicited: challenges to managing suicidal behaviour, fragmented relationships with mental health services, personal attitudes of GPs regarding suicidal behaviour and identified needs to improve suicide prevention in primary care. CONCLUSION: Understanding GPs' perspectives can lead to improved training, resources, and support for primary care professionals, who are frontline providers of mental healthcare. This scoping review suggested there is a lack of evidence around what approaches GPs find effective in managing suicidality and how relationships can be strengthened with mental health services to deliver person-centred integrated care for those identified at risk of suicide.