Abstract：
BACKGROUND: The average age of the menopause in the United Kingdom is 52 but symptoms of the perimenopause (PMP) can start at 40 or earlier. The UK Armed Forces (UKAF) has a young demographic but women serving over the age of 40, potentially with PMP symptoms, has increased. Recent evidence suggested PMP management by Defence GPs was satisfactory but variable. Because of small numbers, Defence GPs have less exposure to the PMP than NHS GPs, a problem exacerbated for Uniformed GPs who have reduced clinical contact time due to military duties.
OBJECTIVE: This study aimed to explore Defence GP knowledge and confidence in managing the PMP, identifying factors contributing to disparities.
METHODS: This study used a sequential mixed-methods approach. A survey with self-rating questions and vignettes was undertaken, followed by semi-structured interviews of selectively sampled respondents.
RESULTS: 164 out of 542 Defence GPs responded to a survey, which identified reasonable knowledge (91.3% managing cases per guidelines) but reduced confidence (54.3%). Regression analysis identified case exposure to the PMP, education, and gender as significant factors affecting confidence in PMP management. Themes identified from interviews which were felt to affect knowledge and confidence included: Characteristics of the GP (such as gender); lifelong learning and reflective practice; professional exposure to, and awareness of, the PMP; the changing demographic of Defence; an integrated PMP service to provide experiential learning. Case exposure and experiential learning emerged as the main drivers for confidence. For Uniformed GPs, this was affected by limited clinical time, but confidence returned once exposed to just a few PMP cases.
CONCLUSIONS: Establishing an integrated PMP service in Defence was seen as crucial for improving care as well as providing educational opportunities through experiential learning for Defence GPs.
OBJECTIVE: This study aimed to explore Defence GP knowledge and confidence in managing the PMP, identifying factors contributing to disparities.
METHODS: This study used a sequential mixed-methods approach. A survey with self-rating questions and vignettes was undertaken, followed by semi-structured interviews of selectively sampled respondents.
RESULTS: 164 out of 542 Defence GPs responded to a survey, which identified reasonable knowledge (91.3% managing cases per guidelines) but reduced confidence (54.3%). Regression analysis identified case exposure to the PMP, education, and gender as significant factors affecting confidence in PMP management. Themes identified from interviews which were felt to affect knowledge and confidence included: Characteristics of the GP (such as gender); lifelong learning and reflective practice; professional exposure to, and awareness of, the PMP; the changing demographic of Defence; an integrated PMP service to provide experiential learning. Case exposure and experiential learning emerged as the main drivers for confidence. For Uniformed GPs, this was affected by limited clinical time, but confidence returned once exposed to just a few PMP cases.
CONCLUSIONS: Establishing an integrated PMP service in Defence was seen as crucial for improving care as well as providing educational opportunities through experiential learning for Defence GPs.
摘要：
背景：英国绝经的平均年龄为52岁，但围绝经期（PMP）的症状可以在40岁或更早开始。英国武装部队（UKAF）人口年轻，但服务于40岁以上的女性，可能有PMP症状，增加了。最近的证据表明，国防GP的PMP管理令人满意，但变化不定。因为数量少,与NHSGP相比，国防GP对PMP的接触较少，由于军事职责而减少了临床接触时间的统一全科医生的问题加剧了。
目的：本研究旨在探索国防GP知识和管理PMP的信心，找出造成差距的因素。
方法：本研究采用序贯混合方法。进行了一项带有自我评级问题和小插曲的调查，其次是选择性抽样受访者的半结构化访谈。
结果：542名国防全科医生中有164名对调查做出了回应，它确定了合理的知识(91.3%根据指南管理病例)，但降低了信心(54.3%)。回归分析确定病例暴露于PMP，教育,性别是影响PMP管理信心的重要因素。从访谈中确定的主题被认为会影响知识和信心，包括：GP的特征（例如性别）；终身学习和反思实践；专业接触，和意识，PMP；不断变化的国防人口；提供体验式学习的综合PMP服务。案例曝光和体验式学习成为自信的主要驱动力。对于统一的全科医生，这受到有限的临床时间的影响，但一旦暴露于少数PMP病例，信心就会恢复。
结论：在国防中建立综合PMP服务被认为对于改善护理以及通过体验式学习为国防全科医生提供教育机会至关重要。
目的：本研究旨在探索国防GP知识和管理PMP的信心，找出造成差距的因素。
方法：本研究采用序贯混合方法。进行了一项带有自我评级问题和小插曲的调查，其次是选择性抽样受访者的半结构化访谈。
结果：542名国防全科医生中有164名对调查做出了回应，它确定了合理的知识(91.3%根据指南管理病例)，但降低了信心(54.3%)。回归分析确定病例暴露于PMP，教育,性别是影响PMP管理信心的重要因素。从访谈中确定的主题被认为会影响知识和信心，包括：GP的特征（例如性别）；终身学习和反思实践；专业接触，和意识，PMP；不断变化的国防人口；提供体验式学习的综合PMP服务。案例曝光和体验式学习成为自信的主要驱动力。对于统一的全科医生，这受到有限的临床时间的影响，但一旦暴露于少数PMP病例，信心就会恢复。
结论：在国防中建立综合PMP服务被认为对于改善护理以及通过体验式学习为国防全科医生提供教育机会至关重要。
