Family practice最新文献

Background: There is a lack of evidence regarding the trajectories of type 2 diabetes until the first clinic visit, including the untreated period after diagnosis.

Objective: We aimed to determine the real-world history of type 2 diabetes until the first clinic visit, including the untreated duration, and to assess the effective timing of the therapeutic intervention.

Methods: A total of 23,622 nondiabetic Japanese workers with a mean (SD) age of 38.8 (11.5) years were retrospectively followed from 2008 to 2022 for annual health checkups. The trajectories of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and body mass index (BMI) until the first clinic visit in diabetes individuals were determined. ROC analysis was performed to assess the contribution of each measure to the first visit.

Results: During a median follow-up of 12.0 years, 1,725 individuals developed type 2 diabetes, of whom 532 individuals visited clinics. HbA1c and FPG trajectories steeply rose in the year before the first clinic visit after their progressive upward trends. ROC analysis showed cutoff values for each measure. As the untreated duration increased, glycemia increased and BMI decreased among individuals who visited clinics.

Conclusions: To prevent the initial worsening of diabetes, early therapeutic intervention is necessary during the increasing trends before the steep rise in glycemia, regardless of the degree of obesity. HbA1c ≥6.5% (47.5 mmol/mol) and an HbA1c ≥0.2% (2.2 mmol/mol)/year increase may be an effective timing for therapeutic intervention.

Introduction: The evolving landscape of general practice (GP)/family medicine (FM) in the post-COVID-19 era, focussing on integrating telemedicine and remote consultations requires a new definition for this specialty. Hence, a broader consensus-based definition of post-COVID-19 GP/FM is warranted.

Methods: This study involved a modified electronic Delphi technique involving 27 specialists working in primary care recruited via convenient and snowball sampling. The Delphi survey was conducted online between August 2022 and April 2023, utilizing the Google Forms platform. Descriptive statistics were employed to analyse consensus across Delphi rounds.

Results: Twenty-six international experts participated in the survey. The retention rate through the second and third Delphi rounds was 96.2% (n = 25). The broader consensus definition emphasizes person-centred care, collaborative patient-physician partnerships, and a holistic approach to health, including managing acute and chronic conditions through in-person or remote access based on patient preferences, medical needs, and local health system organization.

Conclusion: The study highlights the importance of continuity of care, prevention, and coordination with other healthcare professionals as core values of primary care. It also reflects the role of GP/FM in addressing new challenges post-pandemic, such as healthcare delivery beyond standard face-to-face care (e.g. remote consultations) and an increasingly important role in the prevention of infectious diseases. This underscores the need for ongoing research and patient involvement to continually refine and improve primary healthcare delivery in response to changing healthcare landscapes.

Background: The University of New Mexico School of Medicine established the combined baccalaureate/medical degree (BA/MD) program in response to critical physician shortages in New Mexico (NM). This 8-year program aims to improve health care in NM by expanding access to medical education for local students, particularly from rural and underserved communities and/or racial/ethnically underrepresented in medicine (URiM) in NM.

Objectives: To describe the BA/MD program's initial design, the impact of improvements on retention, and the outcomes in terms of physicians in practice, particularly in primary care specialties.

Methods: The study reviews the BA/MD program's progress from 2006 to 2023, focusing on curriculum and support enhancements. Retention rates and choice of primary care specialties were analyzed by geographic origin and racial/ethnic background.

Results: From 2006 to 2023, the program graduated 81 physicians, with 53 practicing in 10 of NM's 33 counties. Approximately two-thirds specialize in primary care, and a similar proportion are URiM. Students from 31 of NM's 33 counties were admitted, with two-thirds coming from outside the state's metropolitan area. Overall retention and retention across demographic groups improved significantly in the baccalaureate phase of the program due to changes in curriculum and support services.

Conclusions: The program has effectively addressed physician shortages in NM, particularly in rural and underserved areas. Its success in training and retaining physicians from diverse backgrounds, with a focus on primary care, is crucial for improving health care access in the state. Ongoing improvements in the program are essential to sustaining and enhancing these outcomes.

Background: When research and management of Dupuytren's disease (DD) shift from symptom relief to preventing contractures, general practitioner (GP) care may become more central to treatment. However, the presentation and course of DD in GP care are underexplored and this has been recognized as a knowledge gap that hinders effective treatment decisions. This study is the first to map the trajectory of DD patients in GP care.

Methods: Using electronic health records from Dutch general practices in a regional research network, we conducted a registration-based cohort study in a dynamic population. Descriptive statistics detailed patient demographics, number of contacts, and symptoms per contact. The time and number of contacts before diagnosis were also analysed. Sankey diagrams illustrated the relationship between management options and symptoms.

Results: Over a 16-year period, 84% of patients with a DD diagnosis had visited their GP for this reason, with 73% only having one GP contact. The diagnosis was made at first contact for 93% of patients. Initial contacts often reported a lump (57.3%), but this symptom was less frequent in subsequent visits. 'Daily life impairment' increased after the first contact. The most common management options were referral to secondary care (37.7%) and watchful waiting (35.1%).

Conclusion: The diagnosis and management of DD in GP care are in line with the current guidelines. Less than half of the DD patients were referred to secondary care during follow-up. This may give room for preventive treatment that limits progression. Future studies should focus on the accuracy of diagnosis and the feasibility of effective treatments in GP care.

Collectively, rare diseases are common, affecting approximately 8% of the population in Canada and the USA. Therefore, the majority of primary care (PC) clinicians will care for patients who are affected or at risk for a genetic disease. Considering the increasing ways in which genetics is being implemented into all areas of healthcare, one way to address these needs and expand the capacity of the PC workforce is through the integration of genetic counselors (GCs) into PC multidisciplinary teams. GCs are Masters-educated allied health professionals with specialized training in molecular genetics, communication, and short-term psychotherapeutic counseling. The current models of GCs in PC mimic other multidisciplinary models. Complex tasks related to genetics, such as pre- and post-test counseling, genetic test selection, and results interpretation, are conducted by GCs, which, in turn, allows physicians, nurse practitioners, and other PC providers to work at the top of their scope of practice. Quality genetics services provided by GCs improve clinical outcomes for patients and their families; the simultaneous provision of genetic education and psychological support by a GC is associated with an increase in patient knowledge, perceived personal control, decrease in distress, and can lead to positive health behavior changes, all of which are aligned with the goals of primary healthcare. With their extensive training in clinical care, medical communication, and psychotherapeutic counseling, integrating GCs into PC care teams will improve the care patients receive and allow PC clinicians to ensure their patients are at the forefront of the personalized medicine revolution.

Background: Cancer is a major global cause of death, and primary care is crucial for cancer prevention and early detection. However, there is conflicting information on the effectiveness, implementation, and sustainability of cancer control interventions in primary care.

Objective: This study aimed to summarize the evidence for cancer control in primary care, focussing on identifying relevant factors for implementation and sustainability.

Study setting and design: We conducted a narrative, mixed-methods review of systematic reviews, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Four databases were screened, and two independent reviewers selected studies reporting on cancer prevention, screening, or early detection in primary or community settings. We analysed findings using the extended Reach-Effectiveness-Adopt-Implementation-Maintenance (RE-AIM) Framework.

Principal findings: From the 37 reviews that met the inclusion criteria, 6 focussed on primary prevention, 23 on screening, and 12 on early detection. Most reviews (78%) addressed intervention effectiveness, such as HPV vaccination, tobacco cessation, and cervical, breast, and colorectal screening. One-third of the reviews mentioned adoption and implementation factors, including barriers and facilitators to the implementation of cancer screening programs. Only one review addressed maintenance and sustainability factors, exploring continuous resources and funding strategies.

Conclusion: While numerous interventions are effective for cancer prevention and detection in primary care, literature on implementation and sustainability strategies is lacking. Focusing on continuous resources and funding for cancer strategies in primary care may aid sustainability. Future research should prioritize reporting on implementation and sustainability factors to enhance cancer prevention and control in primary care settings.

Background: Guidelines recommend follow-up within 2 weeks for patients starting medication for depression. Knowledge is lacking about how general practitioners' (GPs) follow-up varies with patients' sociodemographic characteristics.

Objective: To describe follow-up by GP and specialist in mental healthcare provided to men and women with depression within 3 months of starting drug therapy. Furthermore, to examine whether follow-up varied according to patients' age and education.

Methods: Registry-based cohort study comprising all patients aged ≥18 years in Norway with a new depression episode in 2014 who started on antidepressants within 12 months from diagnosis. Patients' age and educational level were the exposures. Outcomes were follow-up by GP and/or mental healthcare specialist, and talking therapy with GP, within 90 days of first prescription. Cox proportional hazard models were used to estimate the likelihood of having follow-up contacts. Log binomial regression analysis was performed to explore the likelihood of having talking therapy with a GP. Time to first contact was illustrated by Kaplan-Meier survival curves.

Results: The study population comprised 17 000 patients, mean age 45.7 years, 60.6% women. Only 27.8% of the patients were followed up by GP and/or specialist within 2 weeks of the first drug dispensing, 67.1% within 90 days. Older or less educated men and women received less and later contacts than the younger or more highly educated.

Conclusions: Differences in age and educational level were associated with follow-up of depressed patients who started medication. This may indicate unwarranted variation in depression care that GPs should consider when prescribing antidepressants.