Family practice最新文献

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).

Background: Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality, particularly among older adults and individuals with chronic conditions. Early detection at the primary healthcare (PHC) level is essential to prevent unnecessary hospitalizations, ensure timely treatment, and reduce antibiotic misuse. This qualitative process evaluation examines the implementation of a collaborative quality improvement initiative aimed at enhancing early detection of ARIs in PHC settings in Mendoza, Argentina.

Methods: The intervention, which included the National Early Warning Score 2 (NEWS2), a triage system, and portable pulse oximeters, sought to recognize early clinical deterioration due to ARIs among adults with suspected or confirmed respiratory COVID-19 in PHC. Guided by the Consolidated Framework for Implementation Research, we conducted semi-structured interviews with 23 healthcare professionals to explore facilitators and barriers to implementation.

Results: The intervention's adaptability and design quality were praised, enabling tailored implementation and structured workflows. However, leadership engagement was limited, hindering coordination and resource allocation. Available resources and organizational incentives were insufficient, leading to high workloads and low motivation. External policies lacked formal mandates, reducing perceived legitimacy. Resistance to change and self-efficacy issues limited adoption. Despite these challenges, the intervention improved clinical decision-making and team collaboration, highlighting its potential when supported by strong leadership, adequate resources, and stakeholder involvement.

Conclusion: Findings emphasize the need for formative assessments, tailored strategies to address contextual challenges, and non-economic incentives to enhance implementation success. This study provides valuable insights for optimizing the integration of interventions in resource-constrained settings, particularly during public health crises.

Background: Continuity of care (CoC) is linked to better outcomes. Particularly, older adults and those with chronic conditions, like type 2 diabetes (T2D) and dementia, may benefit from CoC. Individuals with a migration background (MB) face challenges in accessing adequate healthcare. Our aim was to study associations between MB and personal continuity of general practitioner (GP) care among older adults, and in subgroups with T2D and dementia.

Methods: Observational cohort study (2013-8) based on electronic records from 48 Dutch general practices linked to data from Statistics Netherlands. We specifically compared adults who migrated to the Netherlands to those without MB. The Herfindahl-Hirschman Index (HHI; low/medium/high) was used to measure CoC. We used multilevel ordinal regression to estimate associations between MB and CoC, adjusted for follow-up time/age/gender/comorbidity/income/practice.

Results: 46 663 individuals aged ≥50 years were included: 72.9% with no MB, 5.7% with Surinamese, 4.3% Moroccan, 2.7% Turkish, 5.1% European, and 9.3% other MB. Compared with those without MB, persons with a Moroccan MB had lower odds of having moderate or high CoC [odds ratio (OR) 0.81, 95% CI 0.74-0.89], and persons with a European MB had higher odds of having moderate or high CoC (OR 1.16, 95% CI 1.07-1.26). Persons with a Moroccan MB in the T2D subgroup had lower odds of having moderate or high CoC (OR 0.75, 95% CI 0.64-0.89). No differences were found in the dementia subgroup.

Conclusions: This study reveals inequalities in personal continuity of GP care by MB in the Netherlands. Interventions to improve CoC should actively incorporate MB groups to promote equitable CoC.

Background: Unnecessary vitamin tests are among the most frequently mentioned low-value care practices among Dutch general practitioners (GPs). Understanding drivers for vitamin testing from a GP's perspective is key for developing effective interventions.

Objectives: This study explored GPs' perspectives on drivers of vitamin D and B12 testing, focusing on potential differences between GPs in practices with high and low testing rates, using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B) behavioural science framework.

Methods: Laboratory data from 57 primary care centres (PCCs) in the South of the Netherlands (2016-2019) identified the 15 PCCs with the lowest and highest vitamin testing rates. Thirty GPs, one per PCC, were purposively sampled to ensure variation in testing rate and background. Semi-structured interviews (May-July 2020) covered general perceptions, as well as social, cognitive, and motivational factors. Interviews were analysed by mapping factors driving vitamin testing to the COM-B model.

Results: Several medical and non-medical factors affecting vitamin D and B12 test ordering in general practice were identified, which could be linked to all three COM-B components at the GP (e.g. education), patient (e.g. informational material), and service level (e.g. laboratory forms).

Conclusion: Education, feedback on testing behaviour, evidence-based patient informational material, clear evidence-based guidelines, and modification of laboratory request forms by adding test costs and indications of at-risk groups were identified by participants as promising strategies to reduce unnecessary vitamin testing.

Background: Back pain is the leading musculoskeletal reason for visits in general practice. Time constraints on consultations affect diagnostic decisions and the delivery of evidence-based care. This study explored patient and general practitioner (GP) perspectives on digital tools to support decision-making in back pain management.

Methods: We conducted separate focus groups between June and August 2024 with people experiencing back pain and with registered Australian GPs. We analyzed data using thematic analysis with an inductive approach.

Results: We interviewed 23 participants: 13 with back pain and 10 GPs. Patients appreciated digital decision-support tools for increasing knowledge and clarifying persistent questions after consultations. GPs, in contrast, emphasized red flag screening, symptom monitoring, and time savings. Shared concerns included information trustworthiness, lack of personalization, and cost, while facilitators included integration into practice management systems and GP endorsement.

Conclusions: Our findings highlight opportunities to integrate digital decision-support tools at multiple points in GPs' workflows-before, during, and after consultations-to address the needs of both patients with back pain and GPs. When used before consultations, such tools can help patients prepare by increasing their knowledge, supporting more productive discussions, informing decisions about whether a visit is necessary, and assisting GPs in identifying potential red flags. During consultations, the tools can provide clinicians with updates on current evidence and supply educational resources or prescriptions, particularly for evidence-based lifestyle interventions. After consultations, they can support follow-up by monitoring the patient's condition and addressing any persistent questions that may arise.

Background: Academic detailing (AD), a one-on-one evidence-based educational outreach strategy for healthcare providers, has been effective in improving prescribing behavior. However, its impact on diabetes care outcomes in Canada remains underexplored.

Objective: We aimed to compare prescribing and care patterns for type 2 diabetes between physicians who received AD and those who did not.

Methods: We conducted a population-based matched cohort study in Ontario, Canada, using health administrative databases. We included primary care physicians with active billing from September 2020 to September 2022. Each AD physician was matched to a maximum four controls based on index year, region, sex, years in practice, and proportion of patients with diabetes. We assessed monthly clinical outcomes for 12 months pre and 18 months postintervention using mixed-effects models.

Results: The cohort included 372 AD and 1450 control physicians, with balanced demographics. At baseline, AD physicians saw fewer patients (1292 vs. 1526) but delivered more appointments per patient (4.2 vs. 3.0). Both groups had 15% of patients with diabetes. Post-intervention, biosimilar insulin use increased more sharply in the AD group (9.0% vs. 5.6% monthly). AD physicians consistently had higher B12 testing among metformin users (76.5% vs. 60.0%) and greater use of SGLT2 inhibitors or GLP-1 receptor agonists (40.1% vs. 31.5%). A1C control (<8%) remained similar across groups (∼80%). Time × group differences were significant for all outcomes (P < 0.001) except B12 testing (P = 0.790) and A1C levels (P = 0.815).

Conclusions: The AD group saw greater improvements in diabetes prescribing post-intervention. Engaging physicians in AD could enhance diabetes care quality.

Background: Timely diagnosis of dementia is a public health priority, with general practitioners (GPs) central to symptom recognition and assessment. The emergence of biomarkers and anti-amyloid therapies makes accurate, timely diagnosis more critical than ever, introducing new complexities for general practice. Clinical practice guidelines (CPGs) are vital tools to support clinical decision-making, but their applicability to the general practice setting is uncertain.

Objectives: This scoping review analyses how international CPGs define and support the GP's role in the dementia diagnostic process.

Methods: Following the Arksey and O'Malley scoping review framework, five electronic databases and multiple grey literature sources were searched for dementia CPGs published between 2019 and 2025. Guideline quality was assessed using selected domains of the Appraisal of Guidelines for Research & Evaluation II instrument (AGREE II).

Results: Fifteen CPGs from a range of healthcare systems were included. Only two were specifically developed for general practice. While most CPGs positioned GPs as key to timely diagnosis, the recommendations were predominantly developed from a secondary-care perspective and failed to address the fundamental barrier of limited consultation time. Furthermore, practical guidance for GPs on integrating new biomarkers and anti-amyloid therapies was almost absent.

Conclusions: A disconnect exists between CPG recommendations and the realities of general practice, rendering much of the guidance aspirational rather than actionable. To be effective, future guidelines must ensure recommendations are feasible, address resource constraints, and establish clear pathways for the new biological era of dementia care. Without this, general practice will remain ill-equipped to meet the growing challenges of dementia diagnosis and management.

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.