Family practice最新文献

Challenges related to healthcare financing, service availability, accessibility, workforce, and information systems can hinder the implementation and delivery of primary care services, particularly for Lesbian, Gay, Bisexual, Transgender, Queer, and other sexual and gender minority individuals in developing countries like the Philippines. Addressing these issues requires a collaborative, multi-sectoral approach involving government agencies, private sector partners, and community stakeholders.

Background and objectives: Common mental health problems are often diagnosed and treated by primary care physicians, who take care of entire families. Therefore, the methods of primary care interventions involving informal caregivers and their effects on the mental health outcomes of the care recipients suffering from symptoms of depression, anxiety, obsessive-compulsive disorder, or post-traumatic stress disorder shall be examined.

Methods: A systematic literature search was performed in the databases PubMed, Cochrane Library, EMBASE, APA PsycInfo, APA PsycArticles, and PSYNDEX in August 2023 and January 2025. The trial registries International Clinical Trials Registry Platform (ICTRP), clinicaltrials.gov, and the German Clinical Trials Register (DRKS) were searched in October 2023. Clinical trials examining the effects of caregiver interventions in primary care on medical outcomes for patients suffering from symptoms of the common mental health problems in focus were included (PROSPERO: CRD42023460471).

Results: A total of 8825 studies were identified. Two randomized controlled studies, two non-randomized controlled studies, and two study protocols for randomized controlled trials (RCTs) met the inclusion criteria. Interventions in three of four studies revealed improved mental health outcomes in patients. Core elements of these studies contain self-management with the use of information technology, psychoeducation, and peer support. One study did not reveal significant improvements compared to control.

Conclusions: The review indicates, that there can be a potential positive effect of informal caregiver involvement on patients` mental health outcomes. Application of information technology might be useful to manage time invest. Potential methods can be self-management, psychoeducation, and peer support. Further evidence generation in primary care is needed for more solid conclusions.

Background: Patient experience (PX) is one of the important primary care (PC) indicators. Therefore, PX measurement is essential for assessing PC quality. However, no single standard measure has been established. Although the Person-Centered Primary Care Measure (PCPCM) is a comprehensive and concise measure for evaluating PX in PC, the association between the score and clinical outcomes remains unclear.

Objective: This study aimed to assess the association between the PCPCM score and influenza vaccine uptake, an important clinical outcome in PC for all ages.

Methods: This nationwide cross-sectional study conducted in 2022 used an online survey with stratified random sampling in Japan. PX in PC was evaluated using the PCPCM. The outcome variable was influenza vaccine uptake in the past year. A modified Poisson regression analysis was conducted to investigate the relationship between the PCPCM score and influenza vaccine uptake to adjust for possible confounders.

Results: Among 1112 potential participants, 800 responded; 32.4% received influenza vaccination. After adjusting for possible confounders, PX was found to be associated with influenza vaccine uptake (risk ratio [RR] = 2.02, 95% confidence interval [CI], 1.51-2.70 for the highest score quartile, compared with no usual source of care). The relationship between the PCPCM score quartile and vaccine uptake was dose-dependent.

Conclusions: A higher PCPCM score was associated with better influenza vaccine uptake. Because the PCPCM is a concise and validated measure of PX in PC and has been translated into many languages, the results provide important evidence to promote the measurement of PX in PC worldwide.

Background: Anti-M antibodies are relatively common and naturally occurring. When anti-M antibodies cross the placenta, they may cause hemolytic disease of the fetus and newborn (HDFN). Anti-M antibodies account for less than 15 cases of HDFN reported in the published English literature. HDFN can lead to foetal anaemia, hydrops fetalis, hypoxia, heart failure, and even death.

Objective: To review the general guidelines and propose a less intensive management approach of anti-M antibody during pregnancy through the context of a case report.

Methods: We report a 25-year-old healthy pregnant G3P1011 woman presenting for antepartum care. At the time of delivery for the patient's second pregnancy, she was found to have a positive anti-M blood screen, though she birthed a healthy-term infant. For her current pregnancy, the initial and repeat testings for anti-M were positive.

Results: Since multiple samples from this patient were of low levels extensive maternal and foetal monitoring were deemed unnecessary in reflection of further reading and research. The patient had a spontaneous vaginal delivery of her third pregnancy at 38 weeks without complications.

Conclusion: Anti-RBC antibodies, including anti-M, are frequently identified in blood type and screening for pregnant patients. Guidelines call for intensive surveillance during pregnancy; however, knowledge of the specific antibody can help to provide more nuanced and less intensive care. As primary care physicians, being familiar with the guideline and the ability to counsel patients on anticipated care during pregnancy can help with family planning, compliance with testing, and patient anxiety and decrease intensive use of services that may not affect outcomes.

Background: In 2015, the Australian Diabetes Alliance Program (DAP) was implemented in the Hunter New England Local Health District, New South Wales as a collaboration with the Hunter Medicare Local. DAP integrates specialist teams within primary care practices, delivering case conferencing, practice performance reviews, and education sessions.

Objective: To report on practice nurses (PNs) perspectives on the impact of the DAP on their skills, knowledge, and approach in delivering care for adults with type 2 diabetes.

Methods: Three primary care practices with high rates of monitoring haemoglobin A1c (HbA1c) levels (> 90% of patients annually) and three practices with lower rates of monitoring HbA1c levels (< 80% of patients annually) from DAP provided the sampling frame. Interviews were conducted with six PNs, which were transcribed and analysed using codebook thematic analysis.

Results: Overall, DAP was viewed favourably by PNs. Significant improvements in knowledge and skills were reported relating to administering antihyperglycemic agents, insulin, and other injectable therapy, as well as dietary modifications for diabetes management. PNs transferred this knowledge and skills to other patients not participating in DAP. An improvement in the delivery of diabetes care, rather than a change in approach, was also reported by PNs. However, the amount of preparation required for case conferencing in the program was identified as a burden to PNs.

Conclusions: PNs were supportive of DAP and identified knowledge gains that were transferable to other patients. The administrative burdens on PNs need to be considered for scalability of the program.

Introduction: A better understanding of the determinants involved in general practitioners' (GPs) decision-making processes when it comes to prescribing statins as primary prevention in patients with multimorbidity could provide insights for improving implementation of primary prevention guidelines.

Methods: We conducted a qualitative study using a deductive framework-based and inductive analysis of GPs' semi-structured interviews verbatim, from which expertise profiles of prescribers were also drawn. The analytical framework was built from a pragmatic synthesis of the evidence-based medicine, Modelling using Typified Objects (MOT) model of clinical reasoning processes, Theoretical Domains Framework, and shared decision-making frameworks.

Results: Fifteen GPs were interviewed between June 2019 and January 2020. Diabetes seemed to represent a specific motivation for deciding about statin prescription for primary prevention purposes; and in situations of multimorbidity, GPs differentiated between cardiovascular and non-cardiovascular multimorbidity. Expert prescribers seemed to have integrated the utilisation of cardiovascular risk calculation scores throughout their practice, whereas non-expert prescribers considered them difficult to interpret and preferred using more of a "rule of thumb" process. One interviewee used the risk calculation score as a support for discussing statin prescription with the patient.

Conclusion: Our results shed light on the reasons why statins remain under-prescribed for primary prevention and why non-diabetic multimorbid patients have even lower odds of being prescribed a statin. They call for a change in the use of risk assessment scores, by placing them as decision aids, to support and improve personalised shared decision-making discussions as an efficient approach to improve the implementation of recommendations about statins for primary prevention.

Objective: The general population's interest in cardiopulmonary resuscitation (CPR) remains largely unknown. Fewer than one-third of individuals are familiar with CPR, and there are no comprehensive training programs available. This study aimed to examine CPR interest among patients visited in the primary care setting, design a new program, and assess the feasibility and efficacy of the training initiative.

Methods: This two-phase project aimed to (i) examine patients' knowledge and interests and (ii) design and evaluate a training program within the PC setting. Knowledge and interests were assessed using a survey. The training program design adhered to European guidelines. The pilot study assessed effectiveness through self-administered tests, instructor evaluation of the chain of survival, correct use of an automated external defibrillator (AED), and a manikin capable of measuring chest compression.

Results: A total of 243 patients participated. Among them, 26.16% had received prior CPR training, only 5% knew how to perform CPR maneuvers, and 84.8% were interested in learning. A 90-min training program was designed. After the training session (N = 50), all participants reported feeling capable of performing CPR techniques using the AED; 94% demonstrated proficiency in AED use, and 20% performed high-quality chest compressions (correct release, depth, and rate).

Conclusion: The general population had limited knowledge about CPR but was highly interested in acquiring CPR skills. The PC-based training program enabled bystanders to perform CPR and use AEDs, potentially improving survival rates in out-of-hospital cardiac arrests.

Background: In Ireland, a mixed public-private system exists, whereby some patients receive state-funded general practice (GP) care under the General Medical Services (GMS), while private patients (PPs) pay fees. In 2020, the chronic disease management programme was introduced at the practice level to enhance the management of eight conditions. This pay for performance (P4P) programme incentivises GPs to review GMS patients regularly using a structured protocol. It is hypothesized that ineligible PPs receiving 'routine care', receive a poorer standard of care.

Objective: To investigate the effect of P4P on the standard of care between PPs and GMS patients.

Methods: Retrospective cross-sectional study involving 11 GP practices in the Midwest of Ireland. Clinical parameters recorded for the previous 12 months on 25 GMS patients and 25 PPs, matched by age group, sex, and one clinical condition, were collected from each practice. Parameters included vaccination status, and recording of: blood pressure, smoking status, renal function, glycosylated haemoglobin, and lipids.

Results: Data from 550 patients showed that GMS patients were more likely than PPs to have received/been offered vaccinations (influenza (66% vs 26%), COVID-19 (69% vs 23%), pneumococcal (59% vs 15%)). GMS patients were more likely than PPs to have other parameters measured: blood pressure (92% vs 54%); smoking status (84% vs 24%); renal function (90% vs 59%); glycated haemoglobin (87% vs 56%); lipids (89% vs 57%) (P < .001 for all parameters).

Conclusion: Significant disparities exist in the management of chronic disease in Ireland between GMS patients and PPs. Limiting P4P programmes to GMS patients promotes inequality.

Background: Invasive meningococcal disease (IMD) is a severe infectious disease. Although effective preventive and therapeutical strategies are available, the fatality rate remains high in the general population, with an occurrence of meningococcal-related severe sequelae involving 10-20% of survivors. Given the crucial role of general practitioners in recognizing and preventing IMD and its related sequelae, we aim to assess the burden of these conditions in primary care.

Methods: Using an Italian primary care database, the incidence rate of IMD was calculated in the period 2000-2019 by capturing the first diagnosis registered during follow-up. As far as meningococcal-related sequelae are concerned, we identified and clinically evaluated each potential sequela during the first 3 months, from 3 to 12 months, and up to 36 months.

Results: Among 508 patients diagnosed with IMD, 403 (incidence rate: 0.24 per 10,000 person-years) comprised those diagnosed with IMD in patients aged 15 years or older. We ascertained 104 sequelae (20.4%); 76% of them occurred in those aged 25 or older; 42, 27, and 35 were assessed as short-, medium-, or long-term sequelae, respectively. Overall, 4.7% of IMD patients reported physical sequelae, while 12.2% and 5.7% of patients reported neurological and psychological sequelae, respectively.

Conclusion: Our study showed that a substantial proportion of IMD and related sequelae occur in individuals aged over 25, with a non-negligible burden for healthcare systems. As for the paediatric population, effective communication on the relevance of meningococcal vaccination in adults should be proficiently fostered.

Purpose: There is limited evidence about whether a substance use disorder (SUD) is a barrier to breast cancer screening. Because SUDs are highly prevalent in the USA, it is important to establish whether this patient population is less likely to obtain screening.

Methods: This retrospective cohort study included 220 227 patients, with 209 132 having no SUD and 11 095 (5.0%) with SUD based on electronic health record data in a multi-state, Midwestern healthcare system (1 January 2018-31 December 2022). The outcome was the receipt of a mammogram in the 5-year follow-up period. Patients were women aged 40-69 years as of 1 January 2018, with ≥ 2 in-person primary care visits between 2018 and 2022. Covariates included demographics, health services utilization, and physical/psychiatric conditions.

Results: Mean age of the sample was 54.7 (± 8.3) years old. After controlling for confounding, women without any SUDs had more than twice the odds of mammogram receipt compared to those with stimulant use disorder (odds ratio [OR] 2.06; 95% confidence interval [CI]: 1.83-2.33). Women with no SUDs had 89% higher odds of mammogram receipt compared to those with opioid use disorder (OR 1.89; 95% CI: 1.76-2.03), followed by "other" SUDs (OR 1.86; 95% CI: 1.69-2.06), sedative use (OR 1.70; 95% CI: 1.43-2.04), cannabis use (OR 1.58; 95% CI: 1.44-1.74), and alcohol use disorders (OR 1.49; 95% CI: 1.41-1.58).

Conclusions: Despite the high prevalence of SUDs, evidence of preventive service delivery among individuals with SUDs is still lacking. Further research is needed to investigate other healthcare disparities in preventive service delivery among individuals with SUDs.