Family Medicine and Community Health最新文献

Objective: To describe the development, implementation and impact of an oncology primary care clinic within a tertiary cancer centre, designed to enhance survivorship care and ensure continuity for patients with complex cancer histories.

Design: Descriptive review of clinic formation, team structure, training and patient outcomes. Data were collected from electronic medical records, a Patient Outcomes Registry in Research Electronic Data Capture (REDCap) and institutional dashboards. Patient experience was assessed using the Consumer Assessment of Healthcare Providers and Systems Survey, and oncology provider feedback was obtained through written testimonials. Descriptive statistics and frequencies summarise findings.

Setting: University of Cincinnati Cancer Center, a Midwestern tertiary care facility, where the oncology primary care clinic was established in 2020.

Participants: Patients who visited the clinic between January 2021 and June 2025 (N=1138). Patient satisfaction data were available for 288 respondents.

Results: Through June 2025, the clinic saw 1138 unique patients. The majority had adult-onset cancers (87.8%), while a smaller, yet substantial number had childhood (4%), adolescent or young adult (8.3%) onset cancers. Second primary malignancies were documented in 15.7% of the clinic population. Over half of the patients had cardiovascular conditions. Between January 2021 and April 2025, patient satisfaction was high across all domains (N=288). Oncology provider feedback highlights the critical role of an integrated oncology primary care clinic in the management of patients with complex cancer diagnoses.

Conclusions: The establishment of an oncology primary care clinic within a tertiary cancer centre is both feasible and impactful. The clinic's growth and high satisfaction scores underscore its value in addressing the complex needs of cancer survivors. Integrating primary care into oncology settings enhances continuity of care, improves management of comorbidities and supports long-term survivorship. The use of a Patient Outcomes Registry enables ongoing evaluation and quality improvement. This model offers a scalable framework for other institutions seeking to advance comprehensive survivorship care.

Objective: Non-drug interventions (NDIs) are underused in primary care, despite established effectiveness, safety, cost-benefit and guidelines. Existing research exploring barriers and enablers to NDI use primarily focuses on patients' perspectives, leaving general practitioners' (GPs') perspectives underexplored, despite their critical role in NDI delivery. The objective of this study is to explore Australian GPs' experiences and perspectives on the use of NDIs in primary care.

Design: An interview study informed by realist methodology. Transcripts were abductively analysed, with a sample analysed by two researchers, using the Theoretical Domains Framework, which allows identification of individual and contextual factors that influence behaviour, and discussed in team meetings to develop themes.

Setting: Interviews took place either in person or online via Zoom, were audio-recorded and transcribed verbatim.

Participant: A convenience sample of GPs working in Australian primary care.

Result: 14 GPs were interviewed for an average of 59 min. Four themes were developed representing the latent mechanisms underlying GPs' prescription and use of NDIs. (1) Obtaining and sharing knowledge: GPs' learning about NDIs is limited through medical school and continuing education, highlighting gaps in tertiary and specialty training. Sharing knowledge occurs bidirectionally. GPs share their learnt knowledge about NDIs with patients, who in turn share their lived experience knowledge. (2) Considering the patient: patient characteristics, circumstances and actual or perceived expectations influenced GPs' NDI prescription. Influences included financial status, therapeutic relationship, patient motivation, presenting condition and medication expectation. (3) Influence of primary care environment: time constraints, billing and policies influenced when and how GPs used and prescribed NDIs. Interprofessional collaboration and distributing patient resources were strategies used by GPs to overcome barriers. (4) NDIs part of GPs' role and identity: NDIs were prescribed as first-line treatments, preventative strategies or as an adjuvant to medication for both acute or chronic conditions, highlighting NDIs as core to GPs' role and care.

Conclusion: This study reveals the interplay of factors and mechanisms influencing Australian GPs' use of NDIs, including systemic, educational and interpersonal dynamics. To optimise the integration of NDIs in primary care, prioritised training, clearer guidance and better access to evidence-based resources are required.

In recent years, the prevalence of diabetes in China has increased significantly, and approximately 11.9% of Chinese adults had diabetes in 2020. Moreover, there are several rigorous challenges in diabetes prevention and glycaemic control, especially at the primary medical care level. In order to guide primary healthcare providers in providing comprehensive and continuous care to affected patients, the Office for Primary Diabetes Care of the National Basic Public Health Service Program and the Chinese Diabetes Society issued national guidelines for the prevention and control of diabetes at the primary care level in 2025. The management objects were adults with type 2 diabetes aged ≥18 years. The main contents include basic requirements for management, health management process, diagnosis, screening, evaluation, treatment, recognition and management of acute complications, traditional Chinese medicine, referral and health management and education.

‌OBJECTIVE: To analyse trends in mental and substance use disorders among Asian children aged 5-14 years, identify key risk factors (eg, bullying, abuse, lead exposure) and compare gender/age disparities using Global Burden of Disease (GBD) 2021 data. ‌DESIGN: Cross-sectional analysis of the GBD 2021 database, focusing on prevalence, disability-adjusted life years (DALYs) and risk factor associations. ‌SETTING: Population-based study across Asian countries, examining the burdens of mental health, especially substance use disorders in high-prevalence regions. ‌PARTICIPANTS: Children aged 5-14 years in Asia, with gender-stratified subgroups (boys vs girls). ‌RESULT: Anxiety, conduct disorders and autism were primary contributors to mental health burdens. Substance use disorders, though less prevalent, rose notably among boys. Girls showed higher burdens of anxiety/depressive disorders. Bullying and childhood abuse were strongly linked to these conditions. Gender disparities in DALYs highlighted boys' vulnerability to substance use and girls to internalising disorders. ‌CONCLUSION: Urgent, region-specific interventions are needed to address bullying, lead exposure and abuse, with gender-sensitive strategies. The study calls for targeted research and policies to mitigate rising mental health challenges in Asian children.

Objective: Diabetes remission has emerged as an achievable treatment goal, shifting the focus of care from increasing medication use to restoring metabolic health. While clinical trials show that remission is possible in controlled settings, evidence remains limited regarding its implementation in routine care within middle-income, rice-based dietary contexts. This study aims to explore healthcare provider experiences with implementing diabetes remission services in Thailand, focusing on dietary strategies, deprescription practices and patient management in routine care settings.

Design: Qualitative study using semi-structured, in-depth interviews, supplemented by structured questionnaires and programme documents.

Setting: Thirteen healthcare facilities across six Thai regions and two national-level professional or policy organisations.

Participants: 17 key informants purposively sampled for regional, institutional and professional diversity, including physicians, nurses, dietitians and national programme leaders. Data were collected and analysed iteratively until no new insights emerged. Thematic content analysis was conducted in QDA Miner Lite v3.0 with investigator triangulation.

Result: Five major themes emerged: key strengths, success factors, nutritional approaches and lifestyle modification, implementation challenges, and development strategies. Multidisciplinary teamwork, personalised care plans and regular monitoring facilitated service delivery. Culturally adapted dietary strategies, such as low-carbohydrate Thai-style meals and intermittent fasting, were widely used. Challenges included unclear clinical guidelines, limited staffing and technological disparities. Medication deprescription varied across sites due to the absence of standardised protocols. Healthcare providers emphasised the need for community engagement and policy support to enable scale-up. Real-world implementation of diabetes remission services is feasible but challenged by systemic constraints and contextual variability. Flexible, culturally tailored approaches, empowered care teams and supportive policy frameworks are essential for sustainability.

Conclusion: These findings provide practical insights for scaling remission programmes in other middle-income settings. Flexible, culturally tailored clinical pathways, empowered teams and supportive policy and financing are required to sustain outcomes and expand coverage.

Objective: Demographic changes, increasing prevalence of chronically ill and multimorbid patients and the ongoing shortage of general practitioners (GPs) collectively present significant challenges for European general practice. Task delegation from GP to practice nurse (PN)-led patient consultations could be a potential solution to tackle those challenges.Therefore, this study aimed to examine the attitudes of GPs and PNs towards PN-led consultations in general and for specific conditions.

Design: Cross-sectional survey using a self-developed, pretested questionnaire, conducted between September 2023 and November 2024. The questionnaire assessed attitudes towards PN-led consultations, conditions within PN-led consultations, possible benefits and concerns regarding PN-led consultations, sociodemographic characteristics and characteristics on GP offices (GPOs). We performed descriptive statistics, univariable and multivariable regression analyses using SPSS V.27.

Setting: GPOs located in the German federal states of Saxony-Anhalt and Saxony.

Participant: From 2071 contacted GPOs, 437 GPs and 339 PNs participated (GP response rate: 21.1%).

Results: The majority of GPs (61.7%) and PNs (61.2%) were open towards PN-led consultations. In multivariable analysis, GPs showed greater openness if they had prior positive delegation experiences (OR=5.88, 95% CI (3.01 to 11.48)) or already delegated special tasks (OR= 5.34, 95% CI (2.29 to 12.46)). GPs were less open if they worked in urban GPOs (OR=0.44, 95% CI (0.22 to 0.88)) or owned a single GPO (OR=0.41, 95% CI (0.20 to 0.83)). In multivariable analysis, PNs were more open towards PN-led consultations if they had prior positive delegation experiences (OR=3.03, 95% CI (1.12 to 8.18)) and advanced PN training (OR=3.50, 95% CI (1.44; 8.51)).The three most accepted conditions by GPs and PNs for PN-led consultations were chronic wounds, diabetes mellitus and arterial hypertension.

Conclusion: Our findings demonstrate broad openness among both GPs and PNs towards PN-led consultations in German GPOs in general, and for various acute and chronic conditions. PN-led consultations are already partially practised. The results indicate considerable potential for further delegation beyond current national agreements.Future pilot studies should further develop PN roles and provide evidence of feasibility and non-inferiority of PN-led consultations compared to GP-led consultations. Conditions and participant characteristics investigated may serve as a foundation for study design and participant recruitment.

Objective: The primary objective was to evaluate the impact of clinical decision support (CDS) tool integration into primary care visits on depression screening and follow-up rates and to assess whether CDS use improves adherence to Health Resources and Services Administration (HRSA) guidelines for depression screening and follow-up.

Design: This quality improvement evaluation study employed quantitative and qualitative components conducted in parallel to provide complementary insights. Modified Poisson regression with generalised estimating equation (GEE) was used to assess the association between CDS tool use and meeting HRSA criteria for depression screening and follow-up. In addition, semi-structured interviews explored perspectives on the implementation and utility of CDS tools.

Setting: This study was conducted at a federally qualified health centre in Minnesota.

Participant: The dataset included 12 338 patient encounters attributed to 8647 unique patients, covering 2 years of data. Five care providers were recruited through purposive sampling for the semi-structured interviews.

Result: CDS use was significantly associated with an increased likelihood of meeting HRSA depression screening and follow-up criteria (relative risk 1.44, 95% CI 1.34 to 1.55; p<0.001). Qualitative findings suggested that while providers found CDS tools useful, workflow challenges and human-centred practices shaped their effectiveness.

Conclusion: Integrating CDS tools into primary care workflows can enhance adherence to depression screening and follow-up guidelines. However, their effectiveness relies on supportive person-centred approaches, including collaboration and previsit preparation. These findings highlight the need for a balanced approach that integrates technological interventions with human interaction to enhance clinical practices. Future research should investigate how CDS tools are used in practice, address barriers to their adoption and develop strategies to promote their broader use while fostering continued learning among providers.