Family practice最新文献

Background: Telemedicine is a promising tool for integration into primary care, where it can enhance access and continuity of care. In Türkiye, telemedicine has not yet been routinely implemented in primary care, although regulatory and infrastructural preparations are underway. The success of such services depends not only on technical and legal frameworks but also on patients' attitudes.

Objective: This study aimed to assess patients' attitudes toward telemedicine and identify associated factors among adult attendees of family health centers (FHCs) in Türkiye, to inform the planning and implementation of telemedicine services at the primary care level.

Methods: This cross-sectional study was conducted in five FHCs between January and March 2025. Individuals aged 18 and over with Turkish literacy were included. Data were collected via a face-to-face questionnaire, which included demographic items and the validated 18-item Attitude Scale Toward the Use of Telemedicine Services.

Results: Four hundred twenty participants (mean age 30.59 ± 12.67) completed the study; 75.5% were female, and 50% had university-level education. The mean scale score was 58.06 ± 14.88. Higher scores were associated with higher education (P < .001) and better economic status (P = .030). Participants who used mobile health applications (P = .043) and owned an internet-enabled device (P = .007) also had higher scores. Lower scores were observed among those with a disabled or dependent person at home (P = .006) and those with more frequent family physician visits (P = .045).

Conclusion: Patients who were younger, more highly educated, and with greater digital access exhibited more positive attitudes toward telemedicine.

Background: Acute sinusitis is common in general practice. Although typically self-limiting, antibiotics are frequently prescribed despite guideline recommendations to restrict use. It remains unclear whether antibiotic treatment reduces subsequent health care use or work absence.

Objective: To assess how initial treatment with or without antibiotics for acute sinusitis is associated with subsequent health care use and work absence, and to compare phenoxymethylpenicillin (PcV) versus other antibiotics.

Methods: Nationwide registry-based observational cohort study of adults with acute sinusitis (ICPC-2: R75) diagnosed in Norwegian general practice 2012-2019. We compared GP visits, Ear, Nose, and Throat (ENT) specialist visits, repeat antibiotic prescriptions, and sick leave days in antibiotic-treated and untreated episodes. We estimated adjusted differences in outcomes between groups using linear regression (daily outcomes) and negative binomial regression (weekly counts).

Results: We included 627 211 episodes from 413 449 patients. Antibiotics were prescribed in 59% of episodes; 53% received PcV. During the index week, antibiotic use was associated with 1.7 fewer GP visits, 0.1 fewer ENT visits, and 25.1 more sick leave days per 100 episodes. Corresponding figures for the following 4 weeks were: 0.9 fewer GP contacts, 10.7 fewer sick leave days, and 0.6 more antibiotic prescriptions. PcV was associated with slightly more GP visits and re-prescribing than other antibiotics.

Conclusions: Acute sinusitis is followed by a short-term increase in health care use and work absence. Initial antibiotic use was associated with modest short-term differences, but no meaningful reduction in overall follow-up. Findings are consistent with recommendations for restrictive prescribing and narrow-spectrum use when appropriate.

Background: General practitioners (GPs) frequently encounter complex cases that require specialist input. Traditionally, this support is sought via telephone consultations, which are often constrained by time and availability, or through initiating a hospital referral. Interdisciplinary electronic consultations enable timely specialist advice while possibly reducing unnecessary referrals. Though prior research has shown promising outcomes for e-consultations, evidence remains limited, particularly from healthcare systems where GPs act as gatekeepers, such as in The Netherlands. It is also unclear whether similar benefits apply across other hospital departments.

Objective: This study aimed to evaluate how GPs in a Dutch healthcare setting used e-consultations across multiple hospital departments, focusing on both the content of the consultations and their impact on referral decisions.

Methods: We analyzed 2183 e-consultations submitted to Zuyderland Medical Centre between 2019 and 2022, with at least 24 months of data collected per department. Consultations were categorized by topic, and referral outcomes were assessed-specifically avoided versus additional referrals prompted by the e-consult.

Results: E-consultations were used across all departments and addressed a wide range of clinical questions, most commonly related to diagnosis, diagnostic testing, and pharmacological treatment. In surgical departments, questions more often concerned general advice. Overall, 36.8% were avoided, while 11.9% additional referrals followed the e-consult. Avoided referral rates ranged from 32.6% in Pediatrics to 49.0% in Urology.

Conclusion: E-consultations support GPs in managing clinical uncertainty and may reduce unnecessary referrals, particularly when tailored to departmental contexts.

Background: FINDRISC is a non-invasive, easy-to-use, and free screening tool developed to estimate the 10-year risk of developing type 2 diabetes mellitus (T2DM).

Objective: This study aimed to investigate whether FINDRISC can also predict liver fibrosis risk, as measured by the fibrosis-4 index (FIB-4) in individuals without a diagnosis of T2DM.

Methods: This retrospective cross-sectional study included 1329 adults aged ≥18 years without prior T2DM, based on records from a Family Health Center in Turkey. The FINDRISC results used in T2DM screening were analyzed retrospectively from patient records. FINDRISC scores were calculated from questionnaire results, and FIB-4 was derived from laboratory data (age, alanine aminotransferase, aspartate aminotransferase, platelet count). Chi-square, correlation, and regression analyses were performed, adjusting for gender, smoking, alcohol use, physical activity, and marital status.

Results: Mean FINDRISC scores and FIB-4 were 11.88 ± 6.22 and 1.01 ± 0.80, respectively. Higher FINDRISC categories were associated with older age, female sex, non-smoking, physical inactivity, and obesity. A moderate positive correlation was observed between FINDRISC and FIB-4 (rho = 0.427, P < 0.001). In multivariable regression, FINDRISC emerged as an independent predictor of FIB-4 (β = 0.250, P < 0.001), increasing model variance explained from 6.4% to 12.3%.

Conclusion: FINDRISC, beyond its established role in T2DM risk stratification, may serve as a dual, non-invasive, and free screening tool to identify individuals at increased risk of liver fibrosis. Thanks to its simplicity and self-administered nature, individuals can easily complete the questionnaire at home, enabling early diagnosis of both T2DM and liver fibrosis risk.

Background: Low lean mass (LLM) is a key determinant of morbidity and mortality, particularly in older adults. Although dual-energy X-ray absorptiometry (DXA) is the gold standard for assessment, its high cost and limited availability hinder widespread screening.

Objectives: To develop and evaluate machine learning (ML) models for predicting LLM using easily obtainable demographic and clinical features, based on a cross-sectional analysis of NHANES 2011-2014, focusing on young and middle-aged adults (18-59 years).

Methods: LLM was defined using DXA-derived appendicular skeletal muscle mass adjusted for BMI (ASM/BMI) based on the Foundation for the National Institutes of Health (FNIH) criteria. Six ML algorithms-Logistic Regression, Decision Tree, Random Forest, LightGBM, XGBoost, and Support Vector Machine-were trained using age, gender, height, weight, and handgrip strength.

Results: Among 6045 participants, 7% had LLM. The XGBoost model achieved an AUC of 0.94 (95% CI: 0.92-0.96), an F1-score of 0.54, sensitivity of 46%, and specificity of 98%. Although XGBoost showed the highest numerical F1-score, bootstrap comparisons indicated no statistically significant differences in F1-score across models. In contrast, XGBoost demonstrated significantly higher discrimination than the Decision Tree model according to DeLong's test. All algorithms showed high specificity (>98%) and accuracy (>94%), with markedly variable sensitivity (35%-48%).

Conclusions: Machine learning models using simple and low-cost predictors can estimate the probability of LLM with acceptable discrimination. The proposed model may assist primary care clinicians in risk stratification once externally validated. Further work is needed to establish operational thresholds and evaluate real-world clinical utility.

Context: Few studies on teleconsultation (TC) have focused on comparing the points of view of general practitioners (GPs) and patients.

Objectives: To explore bio-psycho-social situations suitable for TC according to GPs and patients.

Methods: A qualitative study, with thematic analysis, was conducted. Data were collected through individual, semi-directed face-to-face or remote interviews with GPs and patients. The interview guide was validated by a steering committee that included patients. Maximum variation sampling of established GPs and patients was based on diversification criteria.

Results: Thirteen patients and eleven physicians were included in this study. The main condition for TC was a pre-established relationship of trust. It was used on an Ad hoc basis as an alternative to face-to-face consultations. Patients and GPs identified that the use of TC should be the result of a shared decision. Participants agreed on the situations in which the use of TC could be justified: to respond to one-off, specific requests, for benign reasons or reasons not requiring a physical examination. Patients considered their health experience and level of health literacy to be strong determinants of TC use. Participants noted the risk of TC widening certain inequalities in access to care.

Conclusion: Patients and doctors have identified the same suitable situations and the need to respect certain prerequisites. TC seems appropriate when its use is the result of a prior shared decision between patient and GP.

Background: The rapid integration of e-health technologies-such as telehealth, mobile health (mHealth), and electronic health records-has transformed primary care delivery, especially during the COVID-19 pandemic. However, this transformation has revealed significant vulnerabilities in data privacy and security, particularly in decentralized and resource-limited primary care settings. This scoping review aims to map current evidence on privacy and security concerns related to e-health technologies in primary care and to identify mitigation strategies and research gaps.

Methods: A systematic search was conducted in PubMed, ACM, Scopus, and Web of Science for studies published between 2019 and 2024. Eligible studies addressed both privacy/security issues and e-health technology use in primary care. A two-stage screening process and full-text review were applied. Data were extracted and thematically synthesized.

Results: Fifty-two studies were included. E-health technologies examined included teleconsultations, patient portals, digital decision support tools, and artificial intelligence (AI)-based systems. Among included studies, telehealth accounted for 28%, mHealth and wearables 20%, electronic health records 16%, and AI applications 6%. Common concerns involved data breaches, insufficient encryption, lack of interoperability, consent ambiguity, and challenges in securing virtual consultations. Vulnerable groups-such as older adults and low-literacy populations-faced higher risks. Recommended strategies included privacy-by-design principles, secure infrastructure, user-centered design, clearer governance policies, provider training, and hybrid care models.

Conclusion: Addressing privacy and security in e-health requires more than technical solutions. Equitable, safe, and trustworthy systems must incorporate legal, ethical, and human-centered approaches. In primary care, privacy must be positioned as a core element of digital health equity, not an optional enhancement.

Objective: To synthesize evidence on the effectiveness of consultation-based interventions on adherence to primary or secondary preventative medications and clinical outcomes. We focused on consultation-based interventions suitable for primary care settings, without needing specific technologies, and with reasonable time requirements of clinicians.

Methods: A database search was undertaken from 2015 onwards, supplemented by previous systematic reviews and citation-searching. Randomized trials targeting adults prescribed long-term medication for cardiovascular prevention, type 2 diabetes mellitus (T2DM), chronic respiratory disease, or osteoporosis were included. Interventions had to meet a priori eligibility criteria for implementation feasibility in primary care. Two reviewers screened, extracted data, and assessed risk of bias using the Cochrane RoB2 tool. Adherence and clinical outcomes were assessed, with meta-analyses conducted using inverse variance heterogeneity methods and sensitivity analyses to explore heterogeneity.

Results: 41 studies (n = 26 114) were included. Meta-analysis showed significant adherence improvements for T2DM [standardized mean difference (SMD) 0.60, 95% confidence interval (CI) 0.10 to 1.11] and chronic respiratory disease (SMD 0.22, 95% CI 0.07 to 0.38), but effects were not robust to sensitivity analyses. No significant adherence effects were observed for cardiovascular prevention nor osteoporosis. Interventions did not significantly improve clinical outcomes including systolic blood pressure, low-density lipoprotein, HbA1c (after sensitivity analyses), respiratory symptoms, or hospitalization. High heterogeneity and study-level risk of bias limited certainty.

Conclusion: Consultation-based interventions may modestly improve medication adherence in T2DM and chronic respiratory disease, but there is no robust evidence of clinical benefit, nor evidence of effectiveness in other conditions. Intervention feasibility is an important consideration for guiding future research and translating it into practice.

Background: The decision-making process, from diagnosing depression to treatment proposal, involves many interrelated factors. Patient age has been identified as a factor that influences care proposals. Our aim is to investigate the association between how prescribers perceive ageing and their decision-making when treating depression.

Methods: A cross-sectional survey of 57 physicians was conducted. The questionnaire collected socio-demographic data, and ageing semantic differential (ASD) scale to assess ageism. It also examined the reactions to treatment proposals in a clinical vignette about an 82-year-old woman with a single-episode depressive disorder of unspecified severity (mild or moderate). Physicians' reactions to two treatment options-antidepressant medication and psychotherapy-were assessed independently. For each option, participants could indicate whether they were in favor of initiation, against initiation, or had no opinion. Multiple linear regression was used to study the association between ASD and attitudes toward the initiation of antidepressant medication and psychotherapy.

Results: Prescribers' representations of ageing were significantly associated with their therapeutic decisions for late-life depression. When presented with the same clinical vignette, physicians showed substantial variability in treatment preferences. After adjustment, physicians in favor of initiating psychotherapy exhibited significantly more negative views of ageing compared with those opposed to this option. No significant association was observed between ageist attitudes and the decision to initiate antidepressant treatment.

Conclusions: The research underscores the complex role of ageism in medical decision-making and highlights the need for targeted training to mitigate its impact on late-life depression care.

Background: Caregiver burden represents a pressing public health challenge in aging societies. The quality of primary care may shape caregiver experiences, yet current evidence remains scarce.

Objective(s): To examine the association between primary care quality and overall and domain-specific caregiver burden among family caregivers aged ≥60 years in Shirakawa City, Japan.

Methods: We conducted a cross-sectional study involving adults aged ≥60 years in Shirakawa City, Japan, as part of the 2023 Shirakawa Quality of Life (QOL) Project. The sample included 250 family caregivers who self-identified as providing care for a relative. Primary care quality was measured using the Person-Centered Primary Care Measure (PCPCM) (score range: 0-4; higher scores = better quality) and caregiver burden using the Burden Index of Caregivers (BIC) (score range: 0-44; higher scores = greater burden). Multivariable linear regression with multiple imputations was performed.

Results: Higher quality of primary care was significantly associated with lower caregiver burden overall (adjusted β = -2.8; 95% CI, -4.1 to -1.5). Consistent associations were found across time-dependent, emotional, existential, and physical burden domains. A weaker but still statistically significant association emerged from service-related burden.

Conclusion: These findings indicate that person-centered primary care may contribute to reducing multiple dimensions of caregiver burden. Longitudinal studies are needed to clarify causal relationships and guide the development of targeted interventions.