Family practice最新文献

Background: General practice across Europe faces a workforce crisis, with a projected shortfall of up to 1660 general practitioners in Ireland by 2028. While policy interventions have been proposed, a gap remains between the Irish health system's strategic objectives and the day-to-day realities experienced by general practitioners.

Objective: The aim of this study is to explore the perspectives of Irish general practitioners in addressing recruitment and retention challenges in general practice. Specific objectives include identifying solutions and the supports necessary for sustainable future general practice.

Methods: A qualitative study design was employed, utilizing semi-structured online interviews with general practitioners recruited through a network affiliated with a university. Thematic analysis was conducted by four experienced researchers. Data collection continued until thematic saturation was achieved.

Results: Three primary themes emerged: (i) Towards a More Effective Health Service-participants emphasized the necessity for a whole-system approach to address recruitment and retention shortfalls; (ii) Role Clarification, Boundary Setting, and Support-participants highlighted the need for role reallocation within multidisciplinary teams to allow them to focus on complex cases; and (iii) Practice-Level Response-digital infrastructure improvements and administrative task reallocation were identified as key strategies to reduce workload and enhance patient care.

Conclusion: To address the general practice workforce crisis, systemic reforms, expanded multidisciplinary teams, and practice-level adaptations are needed. The findings reflect the importance of general practitioner involvement in healthcare planning and policy development. These insights will inform targeted policy interventions in Ireland and in healthcare systems facing similar workforce challenges.

Introduction: Nurse practitioner (NP) organizations have advocated for expanding the NP scope of practice as a means of meeting the increasing demand for primary care services. Florida enacted the NP unsupervised practice of medicine (UPM) as part of House Bill 607 in July 2020, with the stipulation that autonomous NPs practice within primary care. The objective of this study was to determine the extent to which autonomous NPs in Florida have limited their scope of practice to primary care.

Methods: We obtained a database of the population of autonomous NPs in Florida on 27 August 2024 from the Florida Department of Health, which contained a total of 11 925 NPs. Between November 2024 and February 2025, we randomly sampled 464 autonomous NPs across the state of Florida, ultimately reaching 328 autonomous NP practices.

Results: Of the 328 autonomous NP practices reached, 128 NPs were working in primary care, and 6 NPs were working in non-clinical roles. The remaining 194 autonomous NPs were working clinically in non-primary care settings, with the top five most common being (i) cosmetic and non-standard medical/surgical practices such as antiaging, IV hydration, vitamin infusions, hormonal therapy, and supplements (n = 53), (ii) psychiatry/addiction medicine (n = 53), (iii) emergency/urgent care (n = 20), (iv) inpatient medicine (n = 13), and (v) cardiology (n = 9).

Conclusions: Our study provides strong evidence that many autonomous NPs in Florida have established specialty practices and other services not within the legal scope of practice of Florida law. Stricter enforcement of NP practice within the scope of training and legislation is needed.

Background: Strengthening prenatal bonding during pregnancy may enhance postpartum mother-infant bonding and improve maternal-infant interactions. This study aimed to examine the effect of Bonding-Based Support provided during the perinatal period on prenatal bonding, early period mother-infant bonding indicators, and maternal bonding.

Methods: A randomized controlled trial was conducted with 70 primigravidae with low prenatal bonding scores (intervention group: n = 34; control group: n = 36). In addition to standard hospital care, the intervention group received a "Bonding-Based Support Program," designed to enhance maternal-infant bonding. This hybrid intervention included video-based online training during pregnancy and face-to-face counselling and support immediately after birth. Data were collected using the Maternal Antenatal Attachment Scale (MAAS), the Maternal Attachment Inventory (MAI), and the Early Period Mother-Infant Bonding Indicators Assessment Scale.

Results: Pre-test scores from the Maternal Antenatal Attachment Scale (MAAS) and its sub-dimensions (Attachment Quality and Time Spent on Attachment) showed no significant differences between groups. However, post-test MAAS scores and sub-dimensions were significantly higher in the intervention group. Significant improvements were also observed in the intervention group on the Early Period Mother-Infant Bonding Indicators Assessment Scale. Moreover, maternal bonding assessed by the Maternal Attachment Inventory was significantly better in the intervention group compared to the control.

Conclusion: The findings indicate that providing Bonding-Based Support during the early perinatal period has a positive impact on maternal bonding, as shown by both self-reported measures and observational indicators. This highlights the potential of targeted bonding support programmes to promote early and sustained maternal-infant connections.

Background: Continuity of care is a defining feature of general practice, with strong evidence for improved patient outcomes. Variability in practices' rates of continuity could markedly influence general practitioner (GP) registrars' learning experience. Previous research found "upstream" (registrar previously seen patient) continuity of 43% and "downstream" (follow-up appointment arranged between registrar and patient) continuity of 49% in Australian GP registrars.

Objectives: This study aimed to assess inter-practice variability in registrar experience of continuity of care.

Methods: Cross-sectional analysis (2010-23) from the Registrar Clinical Encounters in Training study of GP registrars' in-consultation clinical experiences. Outcome factors were "upstream" and "downstream" continuity. Inter-practice variability was assessed using median odds ratios (MORs). Outcome variance attributable to practice was estimated within the Bayesian modeling framework using a mixed-effects logistic regression with cross-classified random effects for registrar and practice.

Results: The analysis included 4643 registrars (response rate 93.3%) across 978 practices. 42.5% (289 426) of registrar consults involved "upstream" continuity and 45.5% (313 295) of registrar consults involved "downstream" continuity. The MOR values were 1.47 [credible interval [CrI] (1.44, 1.50)] and 1.40 [CrI (1.38, 1.43)], for "upstream" and "downstream" continuity, respectively, in a model with random effects for practice and registrar; and 1.35 [CrI (1.32, 1.37)] and 1.38 [CrI (1.36, 1.41)], respectively, in the model adjusted for time/registrar/patient/consultation/consultation outcome/practice variables.

Conclusions: Considerable variability exists in continuity of care measures between GP training practices. This has implications for registrars' learning opportunities, particularly in chronic disease management-essential in the context of an aging population. Strategies to improve registrars' continuity of care in practices with lower rates of continuity should be considered.

Background: Dyslipidemia is a major risk factor for cardiovascular disease, with statins widely prescribed to manage lipid levels. However, statin-associated muscle symptoms and the interplay with physical activity (PA) may impact patients' quality of life (QoL). This study aimed to explore the relationship between PA levels and QoL in statin users.

Methods: A cross-sectional study was conducted among 384 adult statin users attending Dokuz Eylül University Family Health Centers. PA was assessed using the International Physical Activity Questionnaire, and QoL was evaluated with the Short Form-36 Health Survey. Due to the non-normal data distribution, nonparametric statistical tests were applied.

Results: Of the participants, 18.2% were inactive, 65.1% minimally active, and 16.7% very active. Higher PA levels were associated with significantly better scores in physical functioning, role limitations due to physical health, energy/fatigue, social functioning, pain, and general health (P < 0.001). Sitting duration was negatively correlated with most Short Form-36 domains. No significant association was found between PA and role limitations due to emotional problems.

Conclusion: Higher physical activity levels are positively associated with better quality of life among statin users, despite potential concerns regarding muscle symptoms. Regular, moderate physical activity may enhance this population's physical and mental health outcomes.

Objective: To explore the effects of comfort care and family participatory care during the perioperative period of cesarean section in obstetrics and gynecology.

Methods: This single-center, randomized controlled trial assigned 90 cesarean women to two groups: control (conventional perioperative care) and observation (comfort and family participatory care). The primary outcome measures included maternal pain [Visual Analog Scale (VAS)], anxiety [Self-Rating Anxiety Scale (SAS)], and depression [Self-Rating Depression Scale (SDS)]. Secondary outcomes included mean arterial pressure and heart rate, adrenaline and cortisol levels, lactation onset time, 24-h postpartum lactation volume, off-bed activity time, anal defecation time, and hospital stay, as well as evaluating maternal self-care ability [Exercise of Self-Care Agency Scale (ESCA)], maternal complications, and maternal satisfaction with nursing assessed using a satisfaction questionnaire at discharge.

Results: The observation group possessed lower VAS at 24, 48, and 72 h postoperatively, and SAS and SDS scores postoperatively, lower mean arterial pressure, heart rate, and adrenaline and cortisol levels, higher scores of self-care skills, self-care responsibility, self-concept, and self-care health knowledge, shorter times to lactation onset, off-bed activity, anal defecation, and hospital stay, greater 24-h postpartum lactation volume, lower incidence rate of complications (4.44% vs 24.44%), and higher nursing satisfaction (97.78% vs 84.22%) compared with the control group (all P < 0.05).

Conclusion: During the perioperative period of cesarean section, comfort care and family participatory care can effectively alleviate postoperative pain, reduce anxiety and depression, improve stress responses, enhance maternal self-care ability and nursing satisfaction, and decrease the incidence of complications.

Introduction: Human papillomaviruses (HPVs) cause several vaccine-preventable cancers, including cervical cancer. In France, HPV vaccination coverage remains low. Decision aids (DAs) can help individuals make informed health choices. This study assessed the impact of an online DA (SOSHPV) on decisional conflict and vaccination intention, and explored user perceptions in real-life contexts.

Methods: A convergent mixed-methods design was used (November 2023-June 2024). The quantitative component included a pre-post questionnaire assessing knowledge, vaccination intention, and decisional conflict. The qualitative component involved semistructured interviews with a subsample of users, analyzed using grounded theory.

Results: Among 943 website visitors, 187 participants (54 males, 12 adolescents) completed the presurvey, and 44 (12 males, 6 adolescents) completed both assessments. Over half (54%) were young parents using the tool to support HPV vaccination decisions for their child. Post-intervention, knowledge improved (P < 0.001), and decisional conflict decreased (P < 0.001). Vaccination intention shifted: 55%-75% in favor and 32%-18% undecided (P < 0.001). Qualitative analysis (n = 12) revealed three themes: social ambivalence around vaccination, the DA as a support for informed choices, and its role in enhancing communication with healthcare providers.

Discussion: This study showed a reduction in decisional conflict and increased vaccination intention. These findings suggest that DAs may play an important role in addressing vaccine hesitancy and supporting value-aligned choices in real-world settings.

Conclusion: This study highlights the potential of an online DA to improve vaccine acceptance by reducing decisional conflict and enhancing dialog. Further research is needed to assess its large-scale impact on vaccine uptake.

Background: The trends in sedative use have varied in recent years. Benzodiazepines and z-drugs are indicated for anxiety and/or sleep disorders but should be limited to short-term use. The aim of this study is to examine trends and patterns in sedative prescribing in Ireland between 2014 and 2022, as well as comparing trends between Ireland and England within the same period.

Methods: Monthly data on medicines prescribed and dispensed in primary care on the means-tested General Medical Services (GMS) scheme in Ireland were used. Volumes of prescribed benzodiazepine and z-drug use and patterns of prescribing, including initiations, discontinuations, chronic use, and high-risk prescribing were summarized per year. Other sedating agents (sedating antihistamines, antidepressants, and antipsychotics) were also analysed. Volume of use outcomes were compared with NHS data from England for the same period.

Results: The rate of benzodiazepine and z-drug dispensings per 1000 GMS population decreased by 5%, from 1531 in 2014 to 1474 in 2022. By comparison in England, there was a steeper decrease of 27% in the dispensing rate and the level of use was substantially lower, falling from 288 dispensings per 1000 population in 2014 to 210 in 2022. In Ireland, dispensing rates were highest amongst women and older age groups. High-risk dispensings of benzodiazepines and z-drugs decreased over the study period.

Discussion: Despite decreases in benzodiazepine and z-drug dispensings, rates remain high in Ireland and may suggest a need for enhanced availability of non-pharmacological interventions, and improved education and deprescribing support for healthcare professionals.

Background: Effective and timely referral to specialist care is a fundamental responsibility of primary care providers, including family physicians, general practitioners, and community health workers. However, challenges in triage can lead to delays, unnecessary referrals, and increased strain on healthcare systems. Advances in artificial intelligence (AI) now offer new opportunities to support referral decision-making at the primary care level.

Objective: This study evaluates the performance and reliability of two AI models as referral decision support tools, using simulated scenarios commonly encountered in primary care settings involving ear, nose, and throat conditions.

Methods: Sixteen clinical vignettes representing common or high-stakes primary care presentations requiring specialist input were presented to each model in both structured clinical and informal patient-language formats. Responses were independently assessed by five otolaryngologists and 10 lay reviewers using a standardized rubric focused on appropriateness, clarity, safety, and usefulness. Quantitative analysis included comparisons of model performance, reviewer agreement, and the impact of prompt structure on output quality.

Results: Both AI models generated safe and clinically appropriate referral recommendations when provided with structured clinical input. No statistically significant differences were observed between the two models across the evaluated domains. Performance declined for one model when prompts were presented in informal language, underscoring the importance of clear input structure. Reviewer agreement was high, confirming the reliability of findings.

Conclusion: AI decision support tools show potential to assist specialist referral triage in primary care. Clear, structured input is essential to maximize safety and reliability.

Background: Chronic kidney disease (CKD) is increasing in prevalence and is associated with substantial morbidity and mortality. Early initiation of cardiorenal protective medications is recommended to improve outcomes. Barriers to implementation include renal function monitoring and resources to initiate and titrate treatment. We aimed to evaluate the feasibility and acceptability of a protocolled point-of-care testing (POCT) pathway to optimise people living with proteinuric CKD in primary care.

Method: A pilot quality improvement study conducted across three general practices in Greater London, United Kingdom. Inclusion criteria were adults (18-80 years) with hypertension and/or type 2 diabetes mellitus, proteinuria, and reduced kidney function (eGFR 30-75 ml/min/1.73m2), who were identified using electronic health records. POCT for creatinine and potassium enabled real-time decision-making using a traffic light clinical decision support system. The primary outcome was recruitment rate and patient acceptability. Secondary efficacy outcomes included medication optimisation and renal function changes.

Results: Twenty-five (52%) of 48 patients agreed to participate. Overall, 23/25 (92%) completed the pathway and 20/25 (80%) achieved pharmacological optimisation. There were no significant adverse events. POCT was successful in 44/57 (77%) of cases and well tolerated by most participants (10/13; 77%). Patient satisfaction was high (12/13; 92%), with most preferring advanced nurse practitioners or pharmacists in future clinics.

Conclusion: A POCT-led CKD optimisation pathway is feasible and well-accepted in primary care. While high medication optimisation rates were achieved, barriers to recruitment and engagement remain. Future studies should evaluate scalability, long-term clinical impact, and cost-effectiveness to inform wider implementation.