Family practice最新文献

Background: This cross-sectional study aimed to describe proportions of patients with indications of alcohol consumption using phosphatidylethanol (PEth), the Alcohol Use Disorders Identification Test (AUDIT), and its consumption-focused version (AUDIT-C), in relation to blood pressure (BP) control, overall and by sex.

Methods: A total of 270 hypertensive primary care patients (ICD-10: I10.9) were stratified into BP control groups: controlled (<140/90 mmHg), uncontrolled (≥140/90 mmHg), and apparent treatment-resistant hypertension (aTRH; ≥140/90 mmHg with ≥3 antihypertensive drugs). A randomized sample from each stratum was invited, baseline data were collected. Alcohol consumption using predefined categories for PEth and AUDIT, and hazardous use (PEth ≥ 0.122 µmol/L; AUDIT ≥ 8; AUDIT-C ≥ 5 for men, ≥4 for women), were analyzed in relation to BP control groups.

Results: Mean age was 67 ± 11 years; 42% were women. PEth indicated high and regular alcohol consumption in 6.4% of controlled, 5.3% of uncontrolled, and 19.2% of aTRH patients (controlled vs. aTRH, P = .027; uncontrolled vs. aTRH, P = .013). AUDIT showed no significant differences in hazardous use between BP groups (P = .865). AUDIT-C identified slightly higher proportions of hazardous use than PEth, across BP groups and sexes. No significant differences were found between BP groups for hazardous use by PEth (P = .339) or AUDIT-C (P = .150).

Conclusions: PEth revealed significantly higher alcohol use in the aTRH group, undetected by AUDIT. AUDIT-C and PEth identified more hazardous use than AUDIT, suggesting their potential to prompt alcohol-related discussions and support evidence-based hypertension care. PEth correlated more strongly with AUDIT-C than with AUDIT.

Clinical trial registration: Retrospectively registered in Clinical Trials, SLSO2022-0143, 2022-12-10.

Background: General practitioners (GPs) play a crucial role in organ donation after euthanasia (ODE). This study explores their knowledge and perspectives regarding medical, ethical, and logistical aspects of ODE to improve patient-centred care and existing guidelines.

Methods: An exploratory study was conducted among Dutch GPs using an expert-validated online questionnaire covering awareness, experiences, barriers, and ethical considerations. Quantitative data were analysed descriptively; qualitative data underwent thematic analysis, following Standards for Reporting Qualitative Research.

Results: Fifty-two GPs participated. Of these, 78% (n = 38) were aware of ODE, 97% (n = 48) had a positive or neutral stance towards ODE, and 31% (n = 15) were familiar with national guidelines. Five themes emerged: (i) patient autonomy and decision-making; (ii) communication and information; (iii) logistical organization; (iv) impact and barriers; and (v) ethical debates. Patient autonomy was reported as central throughout the ODE process, particularly during decision-making and the final phase. Ninety per cent (n = 48) of the GPs preferred assessing whether discussing ODE within that patient's context was appropriate. GPs varied in opinion regarding the preferred timing for discussing ODE: 42% (n = 25) would introduce it during general end-of-life discussions, 27% (n = 16) would wait for the formal euthanasia request, and 17% (n = 10) would choose a patient-tailored moment. GPs expressed concerns regarding extra workload and emotional impact, with 52% (n = 24) hesitant to initiate ODE for these reasons.

Conclusion: GPs play a central role in ODE, applying flexible, patient-tailored approaches supporting patient autonomy. Redistribution of tasks by early organ donation coordinator involvement, improved guidelines, and clear patient information could improve ODE care in Dutch general practice.

Background: Virtual care accelerated to the forefront of family physician (FP) care following the COVID-19 pandemic and continues to play a significant role in patient care. The choice between virtual and in-person primary care must be sensitive to patients' contexts particularly for those with multi-morbidity.

Objectives: This study explored how to make the choice between virtual and in-person FP care for persons living with multi-morbidity that is acceptable to patients and FPs.

Methods: We conducted a constructivist grounded theory study to understand the processes patients and FPs employ when deciding on the mode of primary care delivery. We used individual interviews to understand the perspectives and expectations of patients with multi-morbidity (2+ chronic conditions) and FPs.

Results: There were two main themes revealed in data analysis: Considerations in choosing mode of delivery (including reason for visit, impact on access, technological logistics, and reimbursement for virtual care) and Process for choosing mode of delivery (including endorsing the patient choice when possible and scheduling visits).

Conclusion: This paper integrated the experience of both patients and FPs to understand how to make the choice between virtual and in-person care. This understanding can support the future of FP care where diverse modes of delivery are employed, but currently technological barriers remain. Clinical scheduling systems that depend on telephone interactions between clinic staff and patients do not always support the process patients and FPs indicated they prefer; that is, one that respects patient preference and FP clinical expertise.

Background: Skill mix in primary care is increasing, but introducing new roles to general practice is challenging. Concerns have been raised that the skill mix may add to the general practitioners' (GPs') workload. This study examined whether the skill mix was associated with GPs' working hours, time used on management, and burnout.

Methods: In total, 1659 GPs working in 1045 practices completed a survey assessing working hours, time spent on management and administration, and burnout. Burnout was assessed by the Maslach Burnout Inventory (MBI). A composite score of quartile points was calculated for the three subscales of the MBI, and a score ≥9 was categorized as a high level of burnout. Skill mix was measured as the number of nurses, secretaries, and other healthcare professionals (OHCPs) per GP in practice. OHCPs constituted a broad staff category comprising, among others, physiotherapists, midwives, pharmacists, and psychologists. Associations were investigated by generalized linear models for binary outcomes.

Results: Employment of nurses was associated with a lower probability of burnout, whereas employment of OHCPs was associated with a higher probability of burnout. The latter was found only in partnership GPs, where employment of OHCPs was also associated with an increased number of hours used on management. Skill mix was unrelated to the number of working hours per week.

Conclusions: Task-shifting from GPs to nurses might unburden GPs exposed to high workload, but the results suggest caution when it comes to employing OHCPs in primary care, although causality cannot be determined. Studies with experimental designs are needed to clarify causal mechanisms.

Background: Since patients increasingly have online access to their diagnostic test results, general practitioners (GPs) have reduced control over how this information is communicated. This shift introduces new challenges in communication and interaction with patients and requires a better understanding of how GPs experience and manage communication in an evolving digital healthcare landscape.

Objectives: To explore GPs' experiences and perceived challenges in communicating information about diagnostic test results to patients in the context of increasing digital accessibility.

Methods: In 2024, we conducted a qualitative study using semi-structured interviews with purposively sampled Dutch GPs in the Netherlands. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Key themes reflecting experiences and challenges related to the communication of diagnostic test results were identified.

Results: Eighteen participants were interviewed in the study. Three overarching themes emerged from the data: (i) managing patient expectations; (ii) purpose-driven communication strategies; and (iii) balancing efficiency and patient engagement in communicating test results.

Conclusions: GPs considered patients' online access to diagnostic test results a double-edged sword-while it may support more efficiency in the healthcare process, it also introduces communication challenges, particularly due to patients' misinterpretation of clinically insignificant findings and the use of medical jargon in reports. These findings highlight the need for tailored communication strategies and improvement of information provided in online patient portals.

Background: This study aimed to investigate the effects of sleep hygiene education on blood pressure and sleep quality in patients diagnosed with essential hypertension.

Methods: A randomized controlled trial was conducted with 138 patients with essential hypertension at a family practice center in southern Turkey. Participants completed Pittsburgh Sleep Quality Index (PSQI) and their blood pressure was measured during the initial visit. Patients randomly assigned to the intervention group received sleep hygiene education during the same session. To support adherence, these participants were asked to keep a sleep diary for 8 weeks. At the end of this period, both groups were reassessed using the PSQI and blood pressure measurements. Data were analyzed using SPSS version 22.

Results: In our study, completed with 129 participants, sociodemographic characteristics were similar across groups. In the intervention group, the mean reduction in PSQI score was 3.4 points (95% CI: 2.8-4.0; P < 0.001). Systolic blood pressure decreased by 9.7 mmHg (95% CI: 7-12.5; P < 0.001), and diastolic blood pressure decreased by 6.3 mmHg (95% CI: 4.2-8.4; P < 0.001). No significant changes were observed in the control group.

Conclusions: Sleep hygiene education delivered in a primary care setting significantly improved sleep quality and reduced blood pressure levels in patients with essential hypertension. This approach may also help prevent complications related to hypertension. Clinical trial registration:  ClinicalTrials.gov (Identifier: NCT07257237; registered on 20 November 2025).

Background: Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality, particularly among older adults and individuals with chronic conditions. Early detection at the primary healthcare (PHC) level is essential to prevent unnecessary hospitalizations, ensure timely treatment, and reduce antibiotic misuse. This qualitative process evaluation examines the implementation of a collaborative quality improvement initiative aimed at enhancing early detection of ARIs in PHC settings in Mendoza, Argentina.

Methods: The intervention, which included the National Early Warning Score 2 (NEWS2), a triage system, and portable pulse oximeters, sought to recognize early clinical deterioration due to ARIs among adults with suspected or confirmed respiratory COVID-19 in PHC. Guided by the Consolidated Framework for Implementation Research, we conducted semi-structured interviews with 23 healthcare professionals to explore facilitators and barriers to implementation.

Results: The intervention's adaptability and design quality were praised, enabling tailored implementation and structured workflows. However, leadership engagement was limited, hindering coordination and resource allocation. Available resources and organizational incentives were insufficient, leading to high workloads and low motivation. External policies lacked formal mandates, reducing perceived legitimacy. Resistance to change and self-efficacy issues limited adoption. Despite these challenges, the intervention improved clinical decision-making and team collaboration, highlighting its potential when supported by strong leadership, adequate resources, and stakeholder involvement.

Conclusion: Findings emphasize the need for formative assessments, tailored strategies to address contextual challenges, and non-economic incentives to enhance implementation success. This study provides valuable insights for optimizing the integration of interventions in resource-constrained settings, particularly during public health crises.

Background: Unnecessary vitamin tests are among the most frequently mentioned low-value care practices among Dutch general practitioners (GPs). Understanding drivers for vitamin testing from a GP's perspective is key for developing effective interventions.

Objectives: This study explored GPs' perspectives on drivers of vitamin D and B12 testing, focusing on potential differences between GPs in practices with high and low testing rates, using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B) behavioural science framework.

Methods: Laboratory data from 57 primary care centres (PCCs) in the South of the Netherlands (2016-2019) identified the 15 PCCs with the lowest and highest vitamin testing rates. Thirty GPs, one per PCC, were purposively sampled to ensure variation in testing rate and background. Semi-structured interviews (May-July 2020) covered general perceptions, as well as social, cognitive, and motivational factors. Interviews were analysed by mapping factors driving vitamin testing to the COM-B model.

Results: Several medical and non-medical factors affecting vitamin D and B12 test ordering in general practice were identified, which could be linked to all three COM-B components at the GP (e.g. education), patient (e.g. informational material), and service level (e.g. laboratory forms).

Conclusion: Education, feedback on testing behaviour, evidence-based patient informational material, clear evidence-based guidelines, and modification of laboratory request forms by adding test costs and indications of at-risk groups were identified by participants as promising strategies to reduce unnecessary vitamin testing.

Background: Back pain is the leading musculoskeletal reason for visits in general practice. Time constraints on consultations affect diagnostic decisions and the delivery of evidence-based care. This study explored patient and general practitioner (GP) perspectives on digital tools to support decision-making in back pain management.

Methods: We conducted separate focus groups between June and August 2024 with people experiencing back pain and with registered Australian GPs. We analyzed data using thematic analysis with an inductive approach.

Results: We interviewed 23 participants: 13 with back pain and 10 GPs. Patients appreciated digital decision-support tools for increasing knowledge and clarifying persistent questions after consultations. GPs, in contrast, emphasized red flag screening, symptom monitoring, and time savings. Shared concerns included information trustworthiness, lack of personalization, and cost, while facilitators included integration into practice management systems and GP endorsement.

Conclusions: Our findings highlight opportunities to integrate digital decision-support tools at multiple points in GPs' workflows-before, during, and after consultations-to address the needs of both patients with back pain and GPs. When used before consultations, such tools can help patients prepare by increasing their knowledge, supporting more productive discussions, informing decisions about whether a visit is necessary, and assisting GPs in identifying potential red flags. During consultations, the tools can provide clinicians with updates on current evidence and supply educational resources or prescriptions, particularly for evidence-based lifestyle interventions. After consultations, they can support follow-up by monitoring the patient's condition and addressing any persistent questions that may arise.

Background: Academic detailing (AD), a one-on-one evidence-based educational outreach strategy for healthcare providers, has been effective in improving prescribing behavior. However, its impact on diabetes care outcomes in Canada remains underexplored.

Objective: We aimed to compare prescribing and care patterns for type 2 diabetes between physicians who received AD and those who did not.

Methods: We conducted a population-based matched cohort study in Ontario, Canada, using health administrative databases. We included primary care physicians with active billing from September 2020 to September 2022. Each AD physician was matched to a maximum four controls based on index year, region, sex, years in practice, and proportion of patients with diabetes. We assessed monthly clinical outcomes for 12 months pre and 18 months postintervention using mixed-effects models.

Results: The cohort included 372 AD and 1450 control physicians, with balanced demographics. At baseline, AD physicians saw fewer patients (1292 vs. 1526) but delivered more appointments per patient (4.2 vs. 3.0). Both groups had 15% of patients with diabetes. Post-intervention, biosimilar insulin use increased more sharply in the AD group (9.0% vs. 5.6% monthly). AD physicians consistently had higher B12 testing among metformin users (76.5% vs. 60.0%) and greater use of SGLT2 inhibitors or GLP-1 receptor agonists (40.1% vs. 31.5%). A1C control (<8%) remained similar across groups (∼80%). Time × group differences were significant for all outcomes (P < 0.001) except B12 testing (P = 0.790) and A1C levels (P = 0.815).

Conclusions: The AD group saw greater improvements in diabetes prescribing post-intervention. Engaging physicians in AD could enhance diabetes care quality.