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: 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: Persons with dementia living in the community are vulnerable to service disruptions as they rely on a mix of outpatient care from different types of physicians. To demonstrate how outpatient physician visits evolved among persons with dementia during a health crisis compared to the prior year.

Methods: Using administrative databases, two retrospective cohorts (2019/pre-COVID-19 pandemic; 2020/pandemic) of community-dwelling persons with dementia aged 65+ were identified within three Canadian provinces (Alberta, Ontario, and Quebec). We measured the rates of visits (total/virtual/in-person) to family physicians, cognitive specialists (neurologists, geriatricians, and psychiatrists), and other specialists. Provincial incident rate ratios (IRR) and 95% confidence intervals (CIs) were calculated by comparing three pandemic periods (first wave; interim period; second wave) to the corresponding pre-pandemic periods (reference) and subsequently pooled using a meta-analysis to obtain overall estimates.

Results: Pre-pandemic (n = 160 288) and pandemic (n = 166 392) cohorts had similar characteristics. Although significant increases in family physician visits within provinces were observed during certain periods, there was no significant change in overall estimates compared to pre-pandemic levels. Overall cognitive (IRR 0.85, CI 0.80-0.90) and other specialist (IRR 0.71, 0.56-0.90) visits were significantly lower in the first wave compared to pre-pandemic period. There was a significant increase in virtual visits and a significant decline in in-person visits across all physician types throughout the pandemic periods.

Conclusion: Family physicians are the cornerstone of sustaining dementia care during health crises such as the COVID-19 pandemic, in part due to virtual care. Future research may investigate long-term outcomes of abrupt disruption in specialist and other community care.

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: 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: The challenges associated with administrative workload in primary care have been widely acknowledged and discussed, yet little qualitative research has been conducted to understand experiences of administrative workload among primary care clinicians and administrative staff or to inform strategies to address it.

Objective: To understand experiences of administrative workload in primary care and how areas of concern might be addressed.

Methods: We conducted thirty-six (36) semi-structured qualitative interviews with family physicians, nurse practitioners, and administrative staff working in primary care clinics in the Canadian provinces of Nova Scotia and New Brunswick. We used Braun and Clarke's approach to reflexive thematic analysis, which resonated with our critical qualitative approach and critical relativist epistemology.

Findings: We identified three themes using inductive and descriptive analysis. The first pertains to working without the right tools or guidelines to support administrative processes. The second theme highlights tensions within teamwork surrounding administrative work, which negatively impact team collaboration. The third theme recognizes that primary care components are interconnected and interdependent, and that this needs to be considered when addressing challenges of administrative workload.

Conclusion: Inefficient tools (e.g. some electronic medical records, lack of interconnectivity between information systems, lengthy forms), lack of documentation of processes, lack of training, loss of autonomy over decision-making, interprofessional tensions embedded in system challenges, and Band-Aid solutions to complex problems all increased administrative workload in primary care.

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).