Innovative Technologies and Methods in General Practice: Selected Abstracts from the 97th EGPRN Meeting, Prague, Czech Republic, 12–15 October 2023

state-of-the-art methods for developing trustworthy guidelines in 2023 are based on the methodology developed by the Grading of Recommendations Assessment, Development and Evaluation (short GRADE) working group (WG). GRADE WG started in the year 2000 as an informal collaboration of people interested in addressing the shortcomings of grading systems in healthcare. GRADE WG is evolving and cultivating GRADE methodology as there are to date 35 GRADE guidance papers and more than 60 GRADE-related publications developed by members of GRADE WG. The lecture will introduce some innovative methods developed in recent years within the guidelines field.


Introduction to the conference theme: 'Innovative technologies and methods in general practice'
The theme reflects the advent of modern technologies into general practice, which to a large extent change diagnostic procedures, the way of working and communicating, both with patients and within the health care system.For example, the Czech Republic has become a European leader in using Point-of-care Technologies (POCT) in Primary Care.The arsenal of instrumental diagnostic technology is developing.In addition to cardiovascular and pulmonary diagnostics, sonographic examination has been recently performed in the Point-of-Care Ultrasound (POCUS) regime.Various solutions in IT applications and communication systems, both with patients and within the healthcare system, are also gaining importance.Remote medicine is emerging.These changes are coming very quickly now, and they are not all evaluated in terms of their actual contribution to improving patients' and doctors´ satisfaction and safety, quality of care, or cost-effectiveness.In this area, there is both space and need for research in primary care.Innovative methods include new ways doctors organise their practice and approaches managing their patients´ problems.Benefits or risks of a team/shared practice vs. single practice can be the field of research focus.The Czech Republic is characterised by a predominance of single practices in which independent doctors operate.The Europe-wide trend towards the development of team practices is difficult to apply here.There is a shortage of non-medical staff, and it is more difficult to set up multidisciplinary teams.One example of an inspiring innovation in the competence of a Czech GP is the reimbursement of a psychosomatic intervention provided by GPs with psychosomatic training, including self-reflection and supervision.Its cost-effectiveness needs to be evaluated.General Practice in the Czech Republic is developing successfully.Its importance has grown even more after the COVID-19 pandemic, and it is one of the most frequent career choices for medical students.Both professional and scientific organisations have a strong position and academic workplaces of general practice are also developing.However, primary care research still needs to be strengthened.Tradition, experience, methodological background and institutional support are lacking.,The situation has improved in recent years, thanks to international and interdisciplinary cooperation and some successful local projects.We believe that the ERGPRN conference in Prague will hasten further development of research in primary care in the Czech Republic.

New technology in clinical practice: Will it help the general practitioner?
Niek de Wit university Medical center utrecht, utrecht, the netherlands CONTACT Niek de Wit n.j.dewit@umcutrecht.nlHealthcare systems around the world are under pressure.
Due to the ageing of the population, societal changes and increasing socio-economic inequity, the demand for health care steadily increases.As a result, health expenditures are rising and the healthcare workforce is getting more and more under pressure.Primary care is needed now more than ever.However, primary care is also under pressure because of the ever-increasing demand.In many countries GPs can hardly cope and waiting times for primary care consultation are increasing.As in other healthcare sectors, primary care will not manage to respond to future challenges with the available workforce.Fundamental changes are needed to keep general practice future-proof.Better patient information about when to see their GP.Delegation of tasks to nurses and practice assistants for low complex problems.Possibilities for direct specialist consultation in primary care.In addition, technical innovations in practice organisation and care delivery are needed to balance demand better and available resources in primary care.These technical solutions cover a broad field.Online patient information websites and platforms can adequately answer health questions of the patient, making consultation unnecessary.Discriminating websites with high-quality health information from those of commercially inspired providers proves very difficult for the average patient.Licencing by the government or endorsing by professional primary care organisations may be the

Results:
We collected field notes of all GP practices that initially participated (n = 20), and interviewed three GPs and seven practice nurses from six GP practices who continued participation, and two GPs and two practice nurses from three GP practices who quit participation.Barriers to implementation were organisational issues, low commitment of the GP and practice nurse, negative experiences with participating patients, and an undefined patient group.Facilitators were collaboration within the team, a motivated practice nurse and experienced patient benefits.Strategies to address the barriers included embedding consultations within regular clinical practice, combining consultations, enabling practice nurses to share their experiences with peers, defining patient group and technical support for digital problems.

Conclusion:
The most important barriers and facilitators from GPs' and practice nurses' perspectives on the implementation of a PA programme for cancer survivors in GP practice relate to the organisation domain and patient experiences.This qualitative study results can be used to improve future implementation of lifestyle programmes in primary care.CONTACT Anthony Pairon anthony.pairon@student.uantwerpen.beBackground: Online symptom checkers and digital triage tools are part of a current effort to better assist patients in their healthcare-seeking behaviour.Compliance, in particular, requires a more solid evidence-based approach, with limited evidence currently focusing on intention to comply, rather than quantifying the direct impact on patients' decision-making.Research question: RQ1: How compliant are people with the advice given by a digital self-triage tool?RQ1.1:How do patient, urgency, disease, and triage characteristics influence compliance?RQ2: To what degree do intention to comply and compliance correlate?Methods: A prospective longitudinal observational study was designed as a proof of concept in which an online triage tool was integrated into a GPC website.Routine registration data of the triage system was linked to a second dataset from ICAREdata, containing anonymous patient data from unplannable care systems.Algorithmic data-matching visualised the patient flow through the healthcare system (n = 398).A structured questionnaire gaged the patient's intention pre-and post-advice, the impact of triage on care-seeking behaviour and underlying motivational drivers (n = 99).These results were matched to compare intention to subsequent action.Results: Overall, 67.3% complied with the advice given, which increased to 77% for those receiving non-urgent triage advice (U5).Compliance was associated with utilisation in the weekend v. weeknight (OR 2.9 95% CI 1.3-3.9,p < 0.002).97% of survey respondents believed they required a doctor prior to triage.After utilisation, 88.9% indicated they intended to comply, yet in 26.8% of cases observed, behaviour differed from their stated intention.Conclusion: Patient adherence to triage advice is generally high for the studied tool and in line with current evidence.There is considerable discrepancy between patient behaviour and their declared intention, warranting caution when using the latter as a proximal outcome.Future research on compliance should be of relevant scale and scope and be performed within the tools' intended setting.Blood pressure data was transmitted online from the cuff of the monitors to the central database using the Medistance system of Omron.

Evaluation of the effectiveness of quality committees in primary healthcare in Tajikistan
Results: Family physicians (n = 2,385), internists (n = 988) and cardiologists (n = 232) participated in the study.During 10 four-month long evaluation periods altogether, 4.804821 blood pressure measurements were registered.The daily average number of measurements in the ten periods was between 3.0 and 5.6.Following the ESH diagnostic criteria, the proportion of subjects in optimal, normal and high-normal blood pressure categories were 14%, 13.4% and 16.7%, respectively.Altogether 56% of the measurements belonged to stage 1, 2 and 3 hypertension categories (31.6%, 17.1% and 7.4%, respectively).The average systolic blood pressure values in family physician practices with more than 2,500 patients were higher than those with less than 1,500 patients (141.8 mmHg versus 139.84 mmHg, respectively).

Conclusion:
The low daily average number of blood pressure measurements refers to the limited blood pressure screening capacity of the Hungarian family physicians.In practices with more patients, the blood pressure is generally less controlled.These results suggest the need to reconsider the blood pressure measurement guidelines and further promote home blood pressure measurements.

Innovative methods in the development of trustworthy clinical practice guidelines Miroslav Klugar
solution.Technical innovations in practice organisation may improve the efficiency of primary care delivery.Digital or app-based triage systems positioned as a first response in the practice may better guide the patient to the appropriate primary care deliverer.AI-based digital systems may in future even replace the GP in case of low-risk problems.
interested in addressing the shortcomings of grading systems in healthcare.GRADE WG is evolving and cultivating GRADE methodology as there are to date 35 GRADE guidance papers and more than 60 GRADE-related publications developed by members of GRADE WG.The lecture will introduce some innovative methods developed in recent years within the guidelines field.POSTER PRIZE WINNERDoes

personalised advice about cervical and breast cancer screening effect women's intention to be screened?
This study aims to examine the status of telemedicine in primary care and present a conceptual framework for its understanding.Methods: A classic grounded theory approach was employed for data analysis, adhering to the 'all is data' principle.The study drew on diverse sources, including primarily secondary literature analysis and multiple interviews with telemedicine caregivers, users and stakeholders, with a specific emphasis on the Swedish context.Results: Telemedicine is defined as remotely delivered care assisted by digital technology.It offers substantial 'convenience capital' to patients, saving working hours, travel costs, and leisure time.However, primary care providers exhibit hesitancy towards telemedicine, perceiving it as having low value with few personal contacts hindering integration into blended care models.After the COVID-19 pandemic surge, telemedicine has lost in volume.To overcome this inertia, technical improvements, regulatory adjustments, and remuneration changes are necessary to integrate telemedicine seamlessly into primary care.Adequate training for primary care providers in telemedicine is crucial to recognise its limitations and advantages, including telework opportunities.Conclusion: Telemedicine, providing cost and time-saving benefits, is well-received by patients.Nonetheless, its growth has been impeded by primary care providers' hesitancy.Addressing the mismatch between caregivers and patients is pivotal to ensuring the future success of telemedicine.Overall, the TAPS (Tobacco, Alcohol, Prescription medication, and other Substance use) tool provides a good balance between ease of use, brevity of administration and more extensive screening for substance use disorders.Conclusion: Feasibility appears to be a set of heterogeneous criteria relating to users, including comprehension or satisfaction, and practical aspects, including administration time or format preference.Given the absence of feasibility study guidelines, the criteria synthesised in this review could serve as a basis for screening test feasibility studies in primary care.
Background: Telemedicine, which involves delivering medical care from a distance, has experienced rapid growth due to technological advancements.Physicians' acceptance of telemedicine plays a crucial role in its long-term adoption.Rogers' theory of 'diffusion of innovations' explains the slow progress of telemedicine.Yet, the COVID-19 pandemic accelerated telemedicine usage pushed Rogers' curve of innovation adoption to the right (innovators, early adopters, early majority, late majority and laggards).Retail telemedicine, primarily focusing on minor conditions, has gained traction in Swedish primary care since 2016.Furthermore, Sweden is implementing a national digital text platform for asynchronous contacts in 2023.Research question: Results: Of the 4,911 articles selected, 20 were included and 16 screening tests were studied.Physician feasibility was evaluated with satisfaction questionnaires or qualitative studies, mainly measuring test administration time.Patient feasibility was measured using criteria including 'ease of use, ' comprehension or format preference.Self-administered KEYWORDS Telemedicine; primary care; digital text contacts; grounded theory formats were preferred, especially electronic versions.universityMedicalcenterGroningen,Groningen,the netherlands CONTACT Sophie Ansems s.m.ansems@umcg.nlBackground:Generalpractitioners(GPs)often struggle with the diagnostic uncertainty of distinguishing functional gastrointestinal disorders (FGID) from organic disorders in children with chronic gastrointestinal symptoms.It is essential to limit referrals of children with FGID while not missing organic disorders such as inflammatory bowel disease (IBD).Faecal calprotectin (FCal) testing may be useful as it can safely rule out IBD.Research question: This study evaluates whether FCal testing can reduce referral rates to paediatric specialist care.In the per-protocol analysis,a we found a reduction in referral rates (5.8 vs 20.3%, adjusted OR 0.21; 95% CI 0.09-0.50).Conclusion:Our results do not support the routine use of faecal calprotectin in primary care until the reasons why GPs did not adhere to the recommendations given in the online training are known.How

to implement a physical activity programme in primary care among cancer survivors. Barriers and facilitators from the perspective of the gp and practice nurse
Methods: A qualitative study using data from multiple sources collected during the implementation of the PA programme: field notes, interviews with GPs, and a focus-group with participating practice nurses.We used thematic analyses proposed by Braun & Clarke and two researchers performed inductive coding.All data was collected in Atlas.ti.

triage: How compliant is the patient?
Maternal and child health is a priority for the health system of Tajikistan.However, significant challenges remain, such as limited access to quality antenatal and intranatal care, family planning, and emergency obstetric care.In addition, there is a high rate of premature births and iron and nutrient deficiencies.Research question: To assess the effectiveness of Quality Committees as an innovative technology in improving the quality and availability of services at the PHC level.The activities of the Quality Committees at the level of PHC institutions in the districts have improved the indicators of antenatal care and early childhood nutrition through internal monitoring, continuous education of doctors and nurses at the District and Rural Health Centres, as well as Health Houses on maternal and child health issues.
KEYWORDS Quality committee; effectiveness; primary health care; maternal and child health; tajikistan Digital self-

inverse care law as applied to general practice clinics in the irish midwest: Examining effects through simulated practice closure
GP clinics (n = 112) were mapped across 1,287 SAs.As expected, GP clinics cluster in more urban areas.Most SAs in Co. Clare (63%) and Co. Limerick (66%) are rural.Rural SAs had significantly longer travel distances to GP clinics than urban SAs, and these distances increase further as distance from an urban centre increases.Due to the sparseness of GP clinics in rural locations, simulated closure of GP clinics revealed increasing travel distance to the next closest clinic with increasing level of rurality, in a stepwise fashion (r2 = 0.31).Conclusion: Due to a lack of alternative GP clinic supply, rural communities are more adversely affected by local GP clinic closure.Our methods are replicable and may encourage policymakers to focus on ensuring rural general practice is supported.

, what are the reasons for non-participation, and how do participants rate DSME training? Data from a nationwide survey
Hypertension is a major public health problem and its proper diagnosis and treatment are crucial to reduce cardiovascular morbidity and mortality.Research question:The new Hungarian Hypertension Registry aimed to evaluate the features of blood pressure measurement practice of family physicians and hypertension care specialists and to register the blood pressure values measured during everyday practice.Methods: Omron M3 IT devices were distributed for four months to family physician practices and hypertension outpatient clinics between October 2018 and April 2023.