Journal of primary health care最新文献

Introduction: The Southern Primary Care Research network has been established to support research that uses routinely collected clinical and administrative primary care data to improve health and health equity in the region. Patients are key stakeholders in this work. Understanding their priorities will improve research relevance.

Aim: This study aimed to identify the primary healthcare research priorities of primary care patients in Otago and Southland.

Methods: Focus groups were conducted. Participants discussed issues of health equity, research needs, and use of health data for research. An inductive reflexive thematic approach was used to analyse the dataset from which codes and themes were developed.

Results: Seven focus groups were held with 50 participants from populations with significant health needs across Otago and Southland. Three research themes were developed: communication, access to care, and quality of care. Participants were most concerned with their challenges relating to health literacy; namely knowing which primary healthcare services are available, and communication during the consultation. Participants experienced barriers to accessing health care because of practical, financial, sociocultural, and workforce factors. Enablers to access were community organisations, advocates, and self-advocacy. The theme of quality of care focused on the experience of the patients once they were in the healthcare system. Issues included the care approach, clinician skills and knowledge, and the availability of services.

Discussion: Four research areas with potential to improve health equity were identified: communication of health services, patient-doctor communication, reduction of barriers to access, and improved quality of care. These findings will be used to focus future primary healthcare research in the region.

Introduction: Patients discharged from hospital following alcohol withdrawal may require follow up of chronic nutrition concerns such as malnutrition and micronutrient deficiency. There is little known about the nutrition care provided in the primary healthcare setting supporting patients discharged from hospital.

Aim: The aim of this study was to explore the nutrition care provided across New South Wales for patients discharged post alcohol withdrawal.

Methods: A survey was distributed to all Primary Health Networks (PHNs) in New South Wales (NSW) and included participant demographics, information regarding participant confidence providing nutrition care and the types of care provided in this setting. Survey participants were also invited to undertake a semi-structured interview to explore hospital discharge processes using case studies. Survey responses were descriptively analysed and all data provided were utilised, even if incomplete. Qualitative data were thematically analysed and a description provided.

Results: Of the 37 survey responses, 15 were fully completed with 41.1% of respondents rating themselves as confident to very confident to provide nutrition-related care. Four respondents participated in the follow-on interviews. Three themes emerged: the importance of person-centred and collaborative approaches; barriers to accessing nutrition services; and the impact of COVID-19 on discharge care.

Conclusions: The level of reported confidence was variable among healthcare professionals providing nutrition care to patients discharged from hospital post alcohol withdrawal. This may represent a gap in service provision, implicating the need for advocacy on nutrition care following alcohol withdrawal.

Introduction: Concussion guidelines exist for Aotearoa New Zealand schools for safe return-to-learn/sports, yet are infrequently implemented. We previously co-designed a framework for managing concussion in schools with school and sports stakeholders and students with concussion and their parents, and piloted the framework in 12 schools.

Aim: We explored perceptions of key national, regional, and local stakeholders regarding the value of a FRAmework for maNaging Concussion in Schools (FRANCS) and develop recommendations for wider-scale implementation.

Methods: Using Participatory Action Research, we invited representatives from national and regional healthcare, education, and sporting organisations to participate in semi-structured interviews and focus groups. Forty-five participants were included, and we used thematic analysis for the data.

Results: We defined three main themes. The first theme, 'the school-sport-healthcare nexus', describes the intersection of existing school, sport, and healthcare contexts for management of students with concussions. The second theme, 'FRANCS opportunities and refinement', centred on participants' perceptions of factors of the framework that may influence its implementation. The third theme, 'making it work on a larger scale', related to the need for coordinated efforts and collaborations among various agencies and stakeholders to support a national roll-out.

Discussion: Participants believed there was high value in a national adoption of FRANCS to address significant challenges faced by schools in supporting students with concussion. Competing priorities, concussion knowledge and beliefs, resources, and existing policies were identified to potentially influence wider implementation.

Introduction: Telerehabilitation offers the potential to improve access to specialty rehabilitation for people with mild traumatic brain injury (mTBI) and reduce health disparities for those living in geographically rural/remote areas. The success of telerehabilitation depends on the extent to which the service meets the patient's needs and their ability to access the services remotely.

Aim: This study aims to help Healthcare practitioners and government agencies develop effective and patient-centred telerehabilitation services for mTBI patients.

Methods: Participants were mTBI survivors or close acquaintances of a mTBI patient. The survey involved asking participants to choose between hypothetical rehabilitation scenarios with varying attributes, including the session duration (long or short), location (clinic-based vs telerehabilitation), therapist involvement, inclusion of online resources, associated cost and community COVID-19 threats.

Results: The results suggest that there was a preference for rehabilitation rather than no rehabilitation, with an overall preference for long telerehabilitation sessions. The results differed somewhat between the groups, with people living with a mTBI being more positive towards clinic-based sessions and less impacted by the threat of COVID-19. The results are consistent with the proposition that individuals prefer telerehabilitation appointments. Although preferences differed between groups, the preference for telerehabilitation persisted, driven by time and cost considerations associated with in-person visits.

Discussion: The findings suggest that mTBI patients value rehabilitation services, and that Healthcare practitioners and government agencies should consider offering long telerehabilitation sessions. Further research is warranted to assess the efficacy and feasibility of implementing telerehabilitation programs in clinical settings for mTBI patients.

Introduction: Falls among community-dwelling older adults represent a significant public health concern. A student-led falls prevention initiative was piloted with a group of at-risk clients in Hamilton/Waikato, New Zealand.

Aim: The aim of this study was to evaluate a student-led falls prevention programme from the perspective of a group of initial clients. The programme comprises two key components: strength and balance exercises, and sessions providing falls prevention education (FPE) from the perspective of a group of initial clients.

Methods: Data on perceived effectiveness and overall impact were collected via a post-programme survey.

Results: Participants reported positive perceptions of the programme's effectiveness in enhancing knowledge and preventing falls. Qualitative data revealed multifaceted benefits experienced by participants, indicating the potential efficacy of student-led initiatives in reducing falls among older adults.

Discussion: These initial findings underscore the potential of student-led initiatives in addressing falls prevention and enhancing the wellbeing and safety of aging populations. Further research is warranted to explore the scalability and sustainability of such programmes in broader community settings.

Introduction: Low back pain is a leading cause of morbidity worldwide, but its cause is often non-specific. Imaging should not take place unless there are specific 'red flag' features present, as it does not improve patient outcomes.

Aim: To establish prevalence and factors associated with ordering of imaging for new onset non-specific low back pain (new onset NSLBP) by early-career GPs ('registrars').

Methods: Cross-sectional analysis from a subset of data from the ReCEnT study of GP registrars' clinical experiences (2010-2018). The outcome was whether imaging was ordered for a patient with new onset NSLBP. Analyses employed univariable and multivariable regression.

Results: A total of 2333 GP registrars (96.0% response rate) contributed data from 325,058 consultations, comprising 508,316 patient problems/diagnoses. A total of 3066 problems/diagnoses (0.6%) were new onset NSLBP. Of the 3066 new onset NSLBP problems/diagnoses, 450 (15%) had imaging ordered. In multivariable models, variables significantly associated with imaging for new onset NSLBP were patient age: 35-64 years (adjusted OR 1.55, P = 0.002) or over 65 years (OR 2.32, P < 0.001) compared to patients aged 15-34 years, 'seeking in-consultation help from a supervisor' (OR 1.74, P = 0.009), scheduling of follow-up with the registrar (OR 3.61, P < 0.001) or another GP (OR 2.01, P = 0.013), and 'generation of learning goals' (OR 1.96, P = <0.001). Imaging was negatively associated with referral (OR 0.48, P < 0.001) as was 'prescription of medication' (OR 0.63, P < 0.001).

Discussion: Although Australian GP registrars are taking a considered approach to imaging for NSLBP, the prevalence of imaging likely exceeds optimal levels, at significant cost and potentially poorer patient outcomes. Refinement in guidelines regarding appropriate 'red flags' for imaging may aid in the further reduction of unnecessary imaging.

Introduction: Knee pain is a common reason to consult a general practitioner (GP), but accurate diagnosis poses a challenge for GPs. To support GPs with this diagnostic dilemma in patients with knee pain, a prediction model could be a useful diagnostic decision support tool.

Aim: This study explores the most common diagnoses in patients with knee pain referred by their GP to a primary care orthopaedic clinic, and if this diagnosis can be predicted by patients' age.

Methods: This was a cross-sectional study of medical records of patients with knee pain in the Netherlands, referred by their GP to a primary care orthopaedic clinic between January 2021 and June 2023.

Results: We included 627 patients with a mean age of 53.0 years (s.d. 16.9). Sixty-nine percent of the patients were diagnosed with osteoarthritis of the knee, 9% were diagnosed with patellofemoral pain, followed by a meniscal lesion in 5%. The optimal age threshold is ≥49.5 years for knee osteoarthritis (area under the receiver operator curve (AUC: 0.90, 95% CI: 0.87-0.93), <47.5 years for patellofemoral pain (AUC: 0.87, 95% CI: 0.83-0.91), and <52.5 years for meniscal lesions (AUC: 0.72, 95% CI: 0.64-0.81).

Discussion: In a primary care population presenting with knee pain, in which GPs experience diagnostic challenges, an age threshold of roughly 50 years is a strong predictor for knee osteoarthritis, patellofemoral pain, and meniscal lesions, the three most common diagnoses. This study marks an initial step in simplifying the diagnostic process for knee pain, aiming to illuminate the path to a more predictive diagnostic approach.

Introduction: Research using routinely collected primary health care data can improve health care quality, outcomes, policy, and health equity. Aotearoa New Zealand (NZ) lacked the infrastructure to readily access these data. The Southern Primary Care Research Network (Southern PCRN) has been established to address this issue.

Aim: This study aimed to identify the research priorities of primary health care clinicians and researchers.

Methods: A modified Delphi survey method was used to identify priority general research areas and specific research questions in NZ primary health care. Participants suggested priority research areas and research questions in Round 1. These were grouped thematically and ranked by frequency. Research questions were screened by scope and feasibility. In Round 2, participants ranked the importance of the research questions.

Results: Primary health care access, health workforce, health services, mental health, and models of primary health care were identified as priority research areas. After screening, 23 research questions were included in Round 2. Consensus was reached on 20 questions. The highest-ranked questions suggested implementation and evaluation of annual checks for people with intellectual disability, and evaluating the effects of embedding allied health practitioners and social workers in primary health care teams.

Discussion: Prioritised research areas are consistent with those identified in the literature. However, the priority research questions are emerging topics. This is the first research prioritisation exercise undertaken for the Southern PCRN. Further research is planned to explore patient priorities. These findings will help the Southern PCRN to establish a research agenda in accordance with its mission of improving health equity.