Family practice最新文献

Background: International guidelines consider most antihypertensive medication (AHM) classes as equivalent options for treating primary hypertension. However, limited research has examined whether general practitioners (GPs) share this view or have specific prescribing preferences. Understanding GPs' perspectives is crucial for identifying how guidelines are implemented in daily practice. This study explores the perspectives, preferences, and prescribing practices of Dutch GPs regarding AHM classes in patients with primary hypertension who have no cardiovascular comorbidities or diabetes.

Methods: We conducted a qualitative study with semi-structured interviews among Dutch GPs. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed.

Results: We interviewed 18 Dutch GPs (56% female) and identified three key themes: contextual factors when initiating treatment, preferences for AHM classes, and considerations on combination therapy. GPs consider lifestyle modifications, patient age, and initial blood pressure (BP) when deciding on treatment. Most GPs do not view all AHM classes as interchangeable, with their preferences shaped by perceived efficacy, side effects, and patient-specific factors, including ethnicity and patient preferences. GPs often favour a gradual titration approach, starting with one class before adjusting the dosage or adding another.

Conclusion: GPs adopt a multifaceted, patient-centred approach to hypertension, prioritizing lifestyle interventions and weighing short-term risks against long-term benefits. We identified several discrepancies between guideline recommendations and everyday practice-particularly regarding the perceived non-equivalence of AHM classes and limited support for initiating combination therapy. Incorporating GPs' perspectives into guideline development may lead to more practical, tailored recommendations that improve adherence and patient outcomes in real-world care.

Background: Elderly patients with Type 2 diabetes (T2D) are frequently overtreated with glucose-lowering medication.

Objective: This feasibility study evaluated the implementation of a deprescribing programme (DPP) for general practices, consisting of education, a patient selection tool, practice visits, and an expert support panel, before scaling it in a randomized controlled trial.

Methods: Quantitative evaluation included the number of patients with T2D eligible for deprescribing using medical records and study progress data. Qualitative evaluation entailed the analysis of minutes made during training, and interviews with health care providers (HCPs). The extended normalization process theory guided analysis.

Results: In 10 practices, 55 out of 65 eligible patients were deprescribed glucose-lowering medication, with 22 restarts. Most execution steps were perceived as the practice nurse's responsibility, whereas the general practitioner needed to approve the deprescribing. Practice nurses found the educational training, including peer-to-peer sessions and practice visits, supportive of integrating deprescribing into practice. DPP procedures and tasks not part of the regular care process were not consistently performed. The DPP was adapted to minimize study tasks for HCPs and align study procedures to existing routine procedures.

Conclusion: Implementation of a DPP in general practice requires education, practice visits, and alignment of DPP components to regular care.

Background: Artificial intelligence tools, including large language models such as ChatGPT, are increasingly integrated into clinical and primary care research. However, their ability to assist with specialized statistical tasks, such as sample size estimation, remains largely unexplored.

Methods: We evaluated the accuracy and reproducibility of ChatGPT-4.0 and ChatGPT-4o in estimating sample sizes across 24 standard statistical scenarios. Examples were selected from a statistical textbook and an educational website, covering basic methods such as estimating means, proportions, and correlations. Each example was tested twice per model. Models were accessed through the ChatGPT web interface, with a new independent chat session initiated for each round. Accuracy was assessed using mean and median absolute percentage error compared with validated reference values. Reproducibility was assessed using symmetric mean and median absolute percentage error between rounds. Comparisons were performed using Wilcoxon signed-rank tests.

Results: For ChatGPT-4.0 and ChatGPT-4o, absolute percentage errors ranged from 0% to 15.2% (except one case: 26.3%) and 0% to 14.3%, respectively, with most examples showing errors below 5%. ChatGPT-4o showed better accuracy than ChatGPT-4.0 (mean absolute percentage error: 3.1% vs. 4.1% in round#1, P-value = .01; 2.8% vs. 5.1% in round#2, P-value =.02) and lower symmetric mean absolute percentage error (0.8% vs. 2.5%), though not significant (P-value = .18).

Conclusions: ChatGPT-4.0 and ChatGPT-4o provided reasonably accurate sample size estimates across standard scenarios, with good reproducibility. However, inconsistencies were observed, underscoring the need for cautious interpretation and expert validation. Further research should assess performance in more complex contexts and across a broader range of AI models.

Background: Primary healthcare centers (PHC) play a pivotal role in the first-line management of patients with diabetes and hypertension, major risk factors for heart failure (HF) development. Point-of-care cardiac ultrasound (POCUS), integrated as an extension of the physical examination, holds significant potential to enhance diagnostic accuracy and clinical management in this setting.

Objectives: Evaluate the impact of POCUS on clinical decision-making in patients with HF and at risk of developing HF in PHC and compare POCUS findings with clinical assessment alone, conventional echocardiography, and electrocardiogram results.

Methods: Patients with diabetes, hypertension, or HF symptoms at a PHC underwent POCUS by a trained family physician. The findings were compared with traditional clinical practice. Decisions regarding referral for an echocardiogram or hospital consultation were contrasted with those of two clinicians who do not use POCUS, and the investigator's echocardiographic results were compared with those from conventional echocardiography and electrocardiogram. Data were analyzed using SPSS.

Results: Among 196 patients (66 ± 15 years; 53.6% female), 36.2% had HF symptoms, 89.2% hypertension, and 29.7% diabetes. Investigator requested less echocardiograms (44 vs. 145 and 125) and made less hospital referral (15 vs. 16 and 24). Using POCUS, congestive patients were less than expected (18 vs. 43 cases), and stage B HF patients were more than clinically (44.9% vs. 19.4%). POCUS identified more cases with left ventricular hypertrophy than electrocardiograms (58 vs. 10).

Conclusion: These findings highlight the value of integrating POCUS into routine family physician consultations, particularly for the management of HF and effective risk stratification.

Background: The prevalence of mental health disorders rose when the impact of the COVID-19 pandemic was most pronounced, potentially altering the consumption of antidepressants and anxiolytics. We aimed to evaluate changes in antidepressant and anxiolytic utilization throughout the COVID-19 pandemic era.

Methods: Nationwide drug sales and prescribing data through 01.03.2018-31.12.2022 were sourced from IQVIA Turkey. We assessed mean monthly consumption and expenditure trends of antidepressants and anxiolytics, along with quarterly prescribing levels, across three periods: "before restrictions" (BfR, 01.03.2018-31.03.2020), "during restrictions" (DuR, 01.04.2020-31.03.2022), and "after restrictions" (AfR, 01.04.2022-31.12.2022), using "defined daily dose per 1000 inhabitants per day" (DID) measure.

Results: Antidepressant consumption escalated from 47.9 ± 4.3 DID in BfR to 56.2 ± 8.9 DID in DuR (P < .001), reaching 60.5 ± 8.9 DID in AfR (P < .001 vs. BfR). Anxiolytic use increased from 2.0 ± 0.3 DID in BfR to 2.5 ± 0.3 DID in DuR (P < .001), and to 2.7 ± 0.3 DID in AfR (P < .001 vs. BfR). Expenditure also rose in DuR and AfR for both drug groups (P < .01). Prescribing trends for antidepressants decreased in DuR (P < .001) and showed an insignificant rebound in AfR (P > .05 vs. BfR and DuR), while anxiolytic prescribing surged in DuR (P = .001 vs. BfR) and subsequently reverted in AfR (P > .05 vs. BfR and DuR). These patterns were consistent across both new and ongoing users.

Conclusions: This study showed a sustained increase in the use of antidepressants and anxiolytics following the onset of pandemic despite fluctuations in prescribing, implying a heightened need for pharmacotherapy and greater burden of depressive and anxiety disorders, especially for the latter.

Introduction: Frequent attendance is a phenomenon that increases health expenses and affects the environment and development of health-related activities, reducing the quality of the assistance provided and increasing care pressure. This problem is intensified in primary health care (PHC) due to high workload and limited resources. The objective of this study is to describe the sociodemographic, clinical, psychopathological, and psychosocial profile of adult frequent attenders (FAs) of PHC centres in Europe.

Methods: A systematic review with meta-analysis was carried out between September 2023 and August 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and consulting the PubMed, Embase, Scopus, Web of Science, and PsycINFO databases. From 1008 records, 17 studies were finally selected, with data extraction into content tables.

Results: FAs in PHC are typically middle-aged women with medium to high educational and socioeconomic levels, unemployed or retired, married, and living with their families. They often present chronic diseases and physical or psychological conditions, such as cardiovascular, respiratory, or locomotor issues. Depression, anxiety, and somatization are the most common psychological diagnoses. Psychosocially, they perceive their health as poorer, experience more social dysfunction, and report higher exposure to stress. The meta-analysis supports these findings but shows high heterogeneity (I² ≥ 50%) due to varying measurement tools and national contexts.

Conclusion: FAs in PHC are usually middle-aged women with medium-high socioeconomic status, retired or unemployed, and living with family. They often have chronic, physical, and some psychiatric conditions, with limited quantitative psychosocial assessment.

Background: Pregnancy care in the USA is in crisis, particularly in rural areas. Shortages and maldistribution of care are contributing factors. Family medicine (FM) physicians could be crucial to addressing the crisis.

Objectives: This study compared pregnancy and rural practice intentions of FM residents and FM obstetrics (FMOB) fellows, and current practices of FMOB fellowship alumni.

Method: In this cross-sectional survey study, 25 FM residents, 7 FMOB fellows, and 37 FMOB fellowship alumni completed practice intentions or actual practice surveys. Variables of interest included intention or practice in rural locations and medically underserved areas, and pregnancy-care intentions or practice, including items on delivery types and advanced obstetrics. We used Fisher's exact test to compare residents, fellows, and alumni.

Results: Trainee intention and alumni practice were similar in practice characteristics except a higher rate of residents (80%) and fellows (100%) intended to practice in a medically underserved area (MUA) than alumni (29%) who practiced in an MUA (P < .001 and P = .001, respectively). Specific to pregnancy care, fellows and alumni respectively intended and provided low-risk, high-risk, and cesarean deliveries, and advanced obstetrics at higher rates than resident intentions.

Discussion: Results suggest FMOB fellows are more likely intend to provide pregnancy-related care compared to FM residents, and alumni provide pregnancy-related care at rates similar to fellow intentions. Few FM residents complete obstetrics fellowships. FMOB fellowships alone cannot sufficiently address care shortages. Expanding and promoting FMOB fellowships would increase the pregnancy -care workforce, but more is needed for FM to realize its potential to resolve the crisis.