初级保健中的女性性传播感染：德国的全科医生面临的挑战和策略——一项定性研究。

Women's sexually transmitted infections in primary care: General practitioners' challenges and strategies - A qualitative study in Germany.

机构信息

Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Institute of General Practice, Berlin, Germany.

出版信息

Eur J Gen Pract. 2023 Dec;29(1):2190094. doi: 10.1080/13814788.2023.2190094.

DOI:10.1080/13814788.2023.2190094

PMID:37009841

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10071968/

Abstract

BACKGROUND

The incidence of sexually transmitted infections (STI) is rising. Amongst women, STIs are often asymptomatic and thus likely underreported. STI care in Germany is fragmented. General Practitioners (GPs) could offer accessible care; however, to which extent GPs provide STI care and which challenges they face remains unclear.

OBJECTIVES

To increase understanding of how GPs provide STI care for women in German high-incidence settings and to identify challenges and opportunities for improved care.

METHODS

Between 10/20 and 09/21, we contacted 75 practices using snowball and theoretical sampling. We conducted qualitative guide-assisted interviews with 19 GPs in their practices in Berlin, Germany. Data were analysed using thematic analysis with grounded theory components.

RESULTS

Responsibilities and financing of STI care services were unclear. Most GPs perceived specialised doctors to be responsible for STI care in women; however, many non-STI specialised doctors were the first point of contact for patients and felt responsible to help. (LBTQI) Women were perceived to have less access to care. Stigmatising perceptions of women with STI-related needs were common. Doctors immediately referred patients to other providers, offered STI care for selected cases, or routinely offered primary STI care. GPs' referral strategies were often unsystematic. Those who offered primary STI care perceived patients' need for STI care, showed open attitudes to sexual health, and had undergone further training on STI care.

CONCLUSION

Training regarding STI care, remuneration, and referral pathways should be provided for GPs. Comprehensive STI care could be offered through the cooperation of GPs and specialists.

摘要

背景

性传播感染（STI）的发病率正在上升。在女性中，STI 通常无症状，因此可能报告不足。德国的 STI 护理较为分散。全科医生（GP）可以提供便捷的护理；然而，GP 提供 STI 护理的程度以及他们面临的挑战尚不清楚。

目的

增加对德国高发地区 GP 为女性提供 STI 护理的理解，并确定改善护理的挑战和机会。

方法

在 2020 年 10 月至 2021 年 9 月期间，我们使用雪球抽样和理论抽样联系了 75 家诊所。我们在德国柏林的诊所对 19 名 GP 进行了定性指南辅助访谈。使用扎根理论成分的主题分析对数据进行分析。

结果

STI 护理服务的责任和融资不明确。大多数 GP 认为专门的医生负责女性的 STI 护理；然而，许多非 STI 专科医生是患者的第一接触点，并感到有责任提供帮助。（LBTQI）女性被认为获得护理的机会较少。对有 STI 相关需求的女性的污名化看法很常见。医生会立即将患者转介给其他提供者，为选定的病例提供 STI 护理，或常规提供初级 STI 护理。GP 的转介策略通常是不系统的。那些提供初级 STI 护理的人会察觉到患者对 STI 护理的需求，对性健康持开放态度，并接受过 STI 护理方面的进一步培训。