Family practice最新文献

Background: During coronavirus disease 2019 (COVID-19), people managing multiple chronic conditions (MCCs) experienced barriers to obtaining needed medications. The purposes of this paper are to (i) determine risk factors for difficulty obtaining medications during COVID-19, (ii) document reasons for the difficulty, and (iii) evaluate the impact on later physical and mental health outcomes.

Method: In a randomized controlled trial conducted in 2016-2021, 1969 adult primary care patients were surveyed about physical and mental health both before and during COVID-19. They reported their needs for medication during COVID-19 and any difficulty obtaining them. Reasons for difficulty accessing medications were tabulated descriptively. Logistic regression identified predictors of medication access difficulty. Multivariable linear regression modeled the relationship between access to medications and health outcomes, accounting for pre-COVID health.

Results: In total 13% of participants experienced difficulty accessing needed medications. Compared to the larger sample, those participants were younger, had more MCCs, and had lower income. They were more often female, unmarried, and were facing insecurities in housing, food, or finances (all P < 0.004). Younger age and the presence of socioeconomic insecurity at baseline increased the odds of later difficulty accessing medications. Barriers to access included concerns about contracting COVID-19 (52%), physician or pharmacy inaccessibility (38%), and cost (26%). Adjusting for baseline health, difficulty accessing medications was associated with poorer health at follow up (P = 0.001).

Conclusion: People with socioeconomic disadvantages experienced a disproportionate impact of difficulty obtaining medications and poorer health outcomes due to COVID-19. They may be at greater risk in the event of future pandemics and other societal disruptions.

Background: The Australian National Bowel Cancer Screening Program sends an immunochemical faecal occult blood test to Australians aged 50-74 years to screen for bowel cancer, but uptake is low (40.9%). The SMARTscreen trial demonstrated that sending a short messaging services (SMS) prompt from the participant's general practitioner (GP) increased the proportion of kit returns by 16.5%. This research aimed to determine the acceptability and feasibility of implementing SMARTscreen.

Method: SMARTscreen was a cluster randomized controlled trial set in 21 Australian general practices in regional Australia. Participants and general practice staff involved in the trial were included in this study. Acceptability and feasibility were measured quantitatively by calculating proportions of the SMS received, viewed, or opted out of, and qualitatively by interviewing people who sent and received the SMS.

Results: Of 2914 SMS sent, 2645 SMS (91%) were received by participants, 1128 (43%) people opened the weblink, and 59 (2%) people opted out of receiving future SMS. Interviews with general practice staff (n = 17) and participants (n = 18) found that sending and receiving the SMS was acceptable and feasible. The SMS was considered a low-burden activity that easily integrated into the clinic's workflow without impacting clinicians' time. Participants reported an increased intention to participate in screening, but some people worried the weblink was spam, and some suggested sending it out of working hours.

Conclusion: The SMS-based intervention was widely accepted by GP staff and participants. Future research should test the SMS with and without the weblink, and send the SMS at a more convenient time of the day/week.

Background: Relational continuity is a fundamental component of primary care. The 'Quality in General Practice Trial' (EQuIP-GP), was a 12-month cluster randomized trial, designed to investigate whether financial incentives can improve relational continuity in primary care.

Aim: To examine (i) how financial incentives are perceived and experienced by primary care patients, providers, and practice staff, and (ii) how clinical and organizational routines related to relational continuity are influenced by the introduction of a financial model designed to incentivize relational continuity.

Design and setting: We used a mixed methods case study approach with six of the intervention arm practices participating in the EQuIP-GP trial.

Method: Semi-structured interviews were conducted with patients, providers, practice staff, and intervention facilitators. Intervention facilitators kept structured diaries to capture reflective notes. To contextualize results, practices completed a modified practice attributes survey and patients completed the Primary Care Assessment Tool at baseline and 12 months.

Results: Patient-perceived relational continuity was not impacted by the intervention. Financial incentives were preferred for rewarding, as opposed to incentivizing, quality care; however, they were perceived as a blunt and inflexible instrument. The introduction of the incentive model increased attention to pre-existing organizational routines rather than creating new ones.

Conclusion: Incentive models should be suitably flexible to accommodate diversity in patient and practice needs. Small changes can be made to existing practice routines that will improve awareness and conscientiousness of relational continuity. Further research should examine how feasible these routine changes would be in practices that do not already focus on continuity.

Background: Shifting tasks from General practitioners (GPs) to practice nurses (PNs) could help address the shortage of GPs in Europe. Internationally, PN-led care (PNLC) is feasible and offers similar health outcomes to usual care. However, PN-led consultations (PN-cons) or as PN-led dosage changes for permanent medication (PN-DCPM) are uncommon in German general practice offices (GPO).

Objective: To explore GPs' and PNs' views on the feasibility and acceptability of PN-cons and PN-DCPM in GPOs.

Methods: In this exploratory, qualitative online focus group study, we recruited GPs, GP trainees, PNs and specialized PNs (APN) currently working in German GPO using a qualitative sampling plan. We used a semi-structured self-developed interview guide. Separate focus groups (FGs) were performed for each profession, with audio and video recordings, and the transcripts were analysed using thematic analysis.

Results: Two FGs comprising 15 GPs and three FGs with 26 PNs revealed four major themes: (i) Attitudes towards PN-cons and PN-DCPM, revealing that participants were generally open towards a PN-cons, but were more reserved towards PN-DCPM. (ii) Acceptable reasons for encounters for PN-cons, e.g. diabetes or hypertension, and acceptable medications for PN-DCPM, e.g. antidiabetics, antihypertensive drugs. (iii) Conditions mentioned for implementing PN-led care were e.g. adequate qualification and supervision concepts. (iv) Perceived chances were e.g. time savings and increased quality of care and perceived risks were e.g. fear of treatment errors.

Conclusion: Participants showed openness towards PN-cons and were more reserved towards PN-DCPM in German GPO. Further quantitative studies should assess how acceptance and rejection of PN-led care are distributed among patients, GPs, and PNs.

Background: Despite the increasing presence of women in US medical schools over the past 25 years, gender equity in medical leadership remains elusive. This qualitative study delves deeper into definitions of institutional leadership roles, who they are designed for, and how women currently contribute in unrecognized and uncompensated leadership positions.

Methods: We recruited family physicians who responded to the American Board of Family Medicine 2022 or 2023 graduate survey. We developed a semistructured interview guide following a modified life history approach to uncover women's experiences through the stages from residency to workforce. A qualitative researcher used Zoom to interview 25 geographically and racially diverse early career women physicians. Interviews were transcribed verbatim and analyzed utilizing NVivo software following an Inductive Content Analysis approach.

Results: Three themes emerged from the data. First, the nature of institutionally recognized leadership positions was largely perceived as bureaucratic and disciplinary, which did not appeal to most participants. Second, women engaged in leadership roles that increased practice efficiency, improved working conditions, and added to their emotional labor-without remuneration. Third, women experienced a tension between work and family, but this did not impact their long-term career goals-which remained focused on patient care or lower-level leadership positions.

Conclusion: Increasing the number of women in leadership positions can be achieved through innovative leadership models that prioritize collaboration, flexibility, and work-life balance. Organizations must revise definitions of leadership to expand it to include the valuable, unrewarded work women undertake that advance their goals and overall patient health.

Background: Measuring self-care preparedness may enable better support for patients in general practice.

Objective: This study assessed the relationship between the self-care preparedness index (SCPI) and health-related quality of life (HRQoL) in a longitudinal analysis over 36 months.

Methods: This was a secondary analysis of an intervention group of a randomized controlled trial. Participants were adults (n = 256) with hypertension, diabetes, or coronary artery disease in primary health care. The intervention group was included in the present study since they had answered SCPI as a part of the intervention. The relationship between SCPI and HRQoL (15D) and other outcomes were studied at baseline. The mean changes in SCPI and 15D were calculated from baseline up to 36 months. Regression-based analysis was used to study to what extent the baseline SCPI was associated with the change in SCPI and 15D and to what extent the change in SCPI was associated with the change in 15D.

Results: At baseline, 15D, physical activity, self-rated health, life satisfaction, and patient activation measures had a positive linear relationship with SCPI. Body mass index and depressive symptoms had a negative linear relationship with SCPI. The longitudinal association between changes in SCPI and 15D was statistically significant and positive. The adjusted β was + 0.19 (95% confidence interval: 0.07 to 0.30, P = .002).

Conclusion: Those patients who managed to increase their SCPI over the study period experienced an improvement in HRQoL.

Background: The coronavirus disease 2019 (COVID-19) pandemic and associated infodemic increased depression and anxiety. Proper information can help combat the infodemic and promotes mental health; however, rural residents have more difficulties in getting correct information than urban residents.

Objective: To examine whether the information on COVID-19 provided by the local government maintained the mental health of rural residents in Japan.

Methods: A self-administered questionnaire survey of Okura Village (northern district of Japan) residents aged ≥16 years was conducted in October 2021. The main outcomes, depressive symptoms, psychological distress, and anxiety were measured using the Center for Epidemiologic Studies Depression Scale, Kessler Psychological Distress Scale, and Generalized Anxiety Disorder scale 7-item. Exposure was defined as whether the resident read the leaflet on COVID-19 distributed by the local government. The targeted maximum likelihood estimation was used to analyse the effect of leaflet reading on the main outcomes.

Results: A total of 974 respondents were analysed. Reading the leaflet was significantly lower risk for depressive symptoms relative risk (95% confidence interval): 0.64 (0.43-0.95). Meanwhile, no clear effects of leaflet reading were observed on mental distress and anxiety.

Conclusions: In rural areas with local governments, analogue information may be effective to prevent depression.

Background: Multimorbidity management poses significant challenges for general practitioners (GPs). The aim of this study is to analyse the role of resilience and social support on the burden experienced by GPs in managing patients with multiple health conditions in Portugal.

Methods: Cross-sectional quantitative study conducted among GPs in Portugal using an online questionnaire that included validated measurement tools: Questionnaire of Evaluation of Burden of Management of Multimorbidity in General and Family Medicine (SoGeMM-MGF), European Portuguese Version of the Resilience Scale (ER14), and the Oslo Social Support Scale-3 (OSSS-3) in Portuguese. A multiple linear regression analysis was conducted to examine the factors influencing the burden of managing multimorbidity.

Results: Two hundred and thirty-nine GPs were included, with 76.6% being female and a median age of 35 years. Most participants were specialists (66.9%) and had less than a decade of experience managing multimorbidity. Over 70% had not received specific training in multimorbidity. Female GPs and those with a higher proportion of multimorbid patients in the registries experienced higher burden levels. A multivariate regression model with moderation revealed that the effect of resilience on burden varied depending on the level of social support. Higher resilience was associated with higher burden in the "Poor Social Support" category, while it was associated with lower burden in the "Moderate Social Support" and "Strong Social Support" categories, although not statistically significant.

Conclusions: The study highlights the importance of GPs' social support and resilience in managing the burden of multimorbidity, with poor social support potentially worsening the effects of high resilience.