Journal of Primary Care and Community Health最新文献

Introduction: Uncontrolled hypertension is a leading global public health concern, contributing significantly to cardiovascular disease burden and premature mortality. Crucially, insufficient patient health literacy often underlies poor blood pressure management. Enhancing health literacy therefore offers substantial potential to empower patients, foster beneficial health behaviors, and ultimately achieve effective blood pressure control.

Objective: To evaluate the effects of a health literacy promotion program on health behaviors and systolic and diastolic blood pressure levels in patients with uncontrolled hypertension.

Methods: This quasi-experimental study employed a 2-group pretest-posttest design with 50 patients diagnosed with uncontrolled hypertension. It was conducted at a subdistrict health promoting hospital in Phayao Province, Thailand. Participants were randomly assigned to either an experimental or a control group, with 25 individuals in each. The control group received usual care, while the experimental group participated in a 12-week health literacy promotion program. This intervention comprised small-group activities incorporating the Teach-back method, Ask Me 3, and motivational interviewing, supplemented by home-based phone calls. The program aimed to develop 6 key health literacy skills. Data were analyzed using descriptive statistics, chi-square test, Fisher's exact test, Mann-Whitney U test, paired t-test, independent t-test, and ANCOVA.

Results: The experimental group showed a significant increase in health behavior scores by 8.72 points post-program (95% CI: 6.61, 10.82; P < .001). This increase was 9.52 points greater than that observed in the control group (95% CI: 6.46, 12.58; P < .001; Cohen d = 1.77). Systolic blood pressure decreased by 14.00 mmHg post-program (95% CI: -17.82, -10.18; P < .001). The between-group difference in reduction was -6.97 mmHg (95% CI: -13.33, -0.60; P = .033, Partial η² = 0.094), indicating a significantly larger reduction in the experimental group. Although diastolic blood pressure decreased by 10.24 mmHg post-program (95% CI: -13.72, -6.76; P < .001), this change did not significantly differ from the control group (P = .387).

Conclusions: The health literacy promotion program significantly improved health behaviors and reduced systolic blood pressure, suggesting its feasibility for implementation in primary care settings. Future research should employ larger sample sizes and extended follow-up periods to thoroughly examine the program's long-term effectiveness across diverse populations.

Background: Collecting patients' social determinants of health data allows primary care providers to identify needed services that can address patients' social needs and improve their overall health. Patients' social needs may also be addressed through collaborations between legal and primary care teams, known as medical-legal partnerships (MLPs). We sought to understand patients' experiences with social needs screening (SNS) and MLPs in primary care.

Methods: In 2024, we conducted a web-based survey with a national sample of 502 U.S. adults who had visited a primary care provider in the prior year. The survey assessed patients' experiences with SNS, preferences of SNS delivery and referrals, and perceptions of MLPs. Analyses used multivariable logistic regression models to assess correlates of willingness to use MLPs.

Results: Thirty-eight percent of participants (n = 194) reported having completed a SNS. Of those who completed a SNS, 51% were offered a referral to address their social needs, including 19% who were referred to legal assistance. Approximately 53% of all participants said they were willing to use MLPs. Participants were more willing to use MLPs if they live in rural communities (Odds Ratio [OR] = 1.79, 95% Confidence Interval [CI]: 1.07-3.01) and were aware of SNS (OR = 1.47, 95% CI: 1.05-2.06) and receive public benefits (OR = 0.67, 95% CI: 0.48-0.93).

Conclusion: MLPs are perceived favorably among patients. Establishing MLPs in rural areas may help address social determinants of health in these communities. Next steps in this research include understanding how to build trust in legal representatives in communities with negative experiences with the justice system.

Background: Non-medical drivers of Health (NMDOH) (e.g., discrimination, income) influence the health status of individuals and their families. In primary care, where clinicians are trained to provide continuous, comprehensive care to patients, there is increasing recognition of the complexity to treat patients impacted by adverse NMDOH. Addressing complex needs requires coordinated support from both healthcare and social systems to overcome socioeconomic barriers and improve outcomes. The purpose of this project was to identify barriers that clinic team members encounter when referring patients to resources.

Methods: Focus groups were conducted with Primary Care Providers and staff (e.g., Social Workers) regularly tasked with referring patients to community organizations. Interviews were audio-recorded, transcribed, and analyzed.

Results: Participants described 3 themes related to barriers: (1) PCPs Are Unaware of Appropriate Referral Processes and Services/Scope of Services Available Internally, (2) Constant Fluctuation of Community Resources Limit Access, and (3) Cost, Communication, Transportation, and Paperwork Limit Patient Access to Services. A fourth theme included participants' recommendations for Solutions to Improve the Referral Process and Communication.

Conclusion: Understanding the barriers between healthcare providers and community organizations can provide a guide toward improving referral protocols and access to resources, thus ultimately leading toward a more equitable community.

Background: A healthy lifestyle can slow the progression of chronic conditions and improve quality of life. Lifestyle counseling in Dutch general practices can be further optimized, among other factors by improving collaboration with social work services. To achieve this, it is important to map out the system of lifestyle counseling within and between general practices and social work services, as well as to identify opportunities for improvement.

Methods: Semi-structured individual interviews were conducted with 3 general practitioners (GPs) and 6 practice nurses (PNs), as well as 5 group interviews with in total 15 professionals from social work services. Participants were based in the city of Nijmegen, the Netherlands. The interviews were conducted between March and August 2024. A thematic analysis was performed which resulted in themes and subthemes. Hereafter, the interviews were re-read to examine relationships between subthemes. The themes, subthemes, and relationships formed the basis for developing a causal loop diagram (CLD) and identifying areas for improvement. The CLD was subsequently reviewed through a member check with the same professions.

Results: The system of lifestyle counseling within and between general practices and social work services consists of the following main themes; addressing lifestyle within general practices, referral to social work services from general practices, GP/PNs' overview and knowledge about social work services, contact between GP/PNs and social work services, and patient status exchange between GP/PNs and social work services. These main themes include interrelated variables which facilitate or impede referrals from general practices to social work services, which is illustrated by the CLD. For example, the more patient status information is shared, the better the GP/PNs' understanding of the available social work services.

Conclusion: The CLD illustrates multiple factors that influence the system of lifestyle counseling in and between general practices and social work services. The CLD, together with the improvement points identified in the interviews, leads to actionable strategies to enhance collaboration between general practices and social work services. These strategies include increasing GP/PNs' understanding of the role and activities of social work services, exchange information, as well as strengthening mutual familiarity and facilitating personal contact between professionals in both domains.

First Contact Physiotherapy Practitioners (FCPPs) are working across the UK to deliver musculoskeletal services to patients within general practice. Little is known about the impact of the model and how variation in delivery may lead to different experiences and outcomes of the service amongst patients and general practice staff. This study explored staff and patient experiences of First Contact Physiotherapy in general practice to determine what works, for whom, under what circumstances, and how. Qualitative interviews were conducted in general practice sites across Great Britain. Interviews were based on initial programme theories identified in an earlier realist review and consensus event. We conducted 80 remote interviews with practice staff and patients, and a further 3 interviews with respondents with other roles related to First Contact Physiotherapy provision. All interviews were analysed using a realist approach. Seven overarching theory areas were identified: 1. Awareness of FCPPs; 2. Communication and integration into practice; 3. FCPP approach in primary care; 4. FCPP additional qualifications; 5. Practice workload; 6. FCPP personal development; and 7. Employment models of FCPP. Three key areas were identified as integral to successful service delivery and implementation: FCPP integration; skillset and impact on resource use; and employment model. Findings from this study strengthen the evidence by providing a robust piece of empirical work about the key issues and contexts impacting successful implementation of the FCPP role into general practice, which will aid decision makers when developing First Contact Physiotherapy services.

Introduction/objectives: Despite the efficacy of vaccines in preventing disease and disability and their cost-effectiveness, a proportion of the population remains reluctant to vaccination. Vaccination literacy is one of the main determinants of vaccine decision-making. The aims of this study were to assess the measurement properties of the Hungarian version of a vaccination literacy instrument and describe the level and determinants of vaccination literacy among the Hungarian adult population.

Methods: A cross-sectional study was conducted on a sample of 1205 Hungarian adult respondents within the European Health Literacy Population Survey 2019-2021. The data were collected by computer-assisted telephone survey in December 2020. The questionnaire covered the following topics: sociodemographic data, self-perceived health, social support, and general and vaccination literacy. The instrument's internal consistency was measured using Cronbach's alpha, its reliability was assessed based on the Spearman-Brown correlation coefficient. The construct validity of the questionnaire was examined using principal component analysis based on a polychoric correlation matrix. Multivariate ordered logistic regression analyses investigated the relationship between vaccination literacy and other relevant variables.

Results: The Cronbach's alpha was 0.78, while the Spearman-Brown correlation coefficient was 0.725. The principal component analysis extracted 1 significant factor that explained 69% of the total variance. The Hungarian adult population had a good level of vaccination literacy (mean score: 82.4, 95% CI 74.9-89.8). We found that social support (OR for the moderate support: 1.93, OR for the strong support: 2.19; P < .001 for both), lack of financial deprivation (OR: 2.05, P < .001), and secondary education level (OR: 1.50, P: .024) are positively correlated with vaccination literacy.

Conclusion: We recommend using the vaccination literacy instrument to identify individuals with inadequate vaccination literacy. Interventions focusing on social support and education to promote vaccine-related information would contribute to enhancing vaccination literacy.

The Model for Understanding Success in Quality (MUSIQ) is a framework designed to understand the contextual factors that can influence healthcare quality improvement (QI) initiative implementation. The MUSIQ calculator was originally developed to help clinics identify contextual factors that may affect QI success. This retrospective study adapted the MUSIQ calculator to serve as an evaluative tool for practice facilitators engaged in a colorectal cancer screening initiative. Eight primary care clinics were scored in 6 contextual factors categories using the adapted MUSIQ calculator. Average MUSIQ scores were used to identify high and low contextual factors clinics, and their colorectal cancer screening rates were assessed across a 4-year period of active engagement with the colorectal cancer screening initiative. There were statistically significant, strong, correlations between overall contextual factors scores and colorectal cancer screening rates across all 4 years. There was a statistically significant difference between screening rate changes during the period of active engagement and high or low contextual factors scores (P = .047). There were statistically significant correlations between 3 contextual factors and colorectal cancer screening rate changes with "Microsystem" and "QI Support" having the strongest associations (P < .001). Low or high contextual factors classification statistically significantly predicted colorectal cancer screening rate changes across the observed timeframe (P = .047). By adapting existing tools with a strong track record of success, like MUSIQ, practice facilitators can identify potential challenges earlier in the QI process providing an important opportunity to intervene to prompt greater success.

Introduction: Continuous Glucose Monitors (CGMs) offer critical insight into glucose trends, aiding significantly in overall type 2 diabetes (T2DM) management. Few studies have evaluated pharmacist involvement in CGM management.

Methods: This was a retrospective study, conducted at two primary care offices within a community health system. The aim of this study was to assess pharmacist impact on the deprescribing of high-risk medications in patients with T2DM utilizing CGM data. The primary outcome was the percentage of patients that experienced deprescribing of a high-risk medication (defined as reduction or discontinuation in total daily dosage of insulin, sulfonylureas, and thiazolidinediones). The secondary outcomes were rate of hospitalizations and changes in total daily insulin dose. Chi-square tests and t-tests were utilized to analyze primary and secondary outcomes.

Results: Among 317 participants, 58% of patients on CGMs had pharmacists involved in their care. Of patients in the pharmacist-led group, 11.4% experienced deprescribing of a high-risk medication compared to about 8.3% in the usual care group. Overall, hospitalizations were 3.2% lower in the pharmacist-led group compared to the usual care group during the study period. In addition, patients in the pharmacist-led group experienced a reduction in total daily insulin dose, while an increase in total daily insulin dosage for the usual care group was observed.

Conclusion: While our study did not find a statistically significant difference in pharmacist-led deprescribing, there was a trend towards reduction in high-risk medication use. This suggests potential clinical significance, emphasizing the role of pharmacist involvement in prescribing practices of medications used to treat T2DM, including deprescribing high-risk medications and initiating non-high-risk medications with additional benefits. Further studies are needed to determine a difference in prescribing practice in pharmacist-led management of T2DM.

Introduction: Integrated Behavioral Health (IBH) clinics in primary care offer cost-effective options for receiving mental health (MH) support for Black patients. By tracking specific aspects of social determinants of health (SDOH), more commonly assessed in primary care, IBH programs can provide helpful insights to both MH and primary care providers.

Methods: This retrospective study examined the impact of IBH care delivery on MH and social needs variables in a Black adult patient population. MH outcomes were assessed using the PHQ9 and GAD7, with a positive score being greater than 5.

Results: There were N = 119 Black patients included in analysis. The sample was 83% female and the average age at first visit was 41. There was a significant reduction in both GAD7 (change = -1.8, P < .001) and PHQ9 (change = -2.3, P < .001) scores for patients receiving IBH services. There were no significant differences between those who had a SDOH screen and having an initial elevated GAD7/PHQ9 score.

Conclusion: More culturally inclusive research on the impact of IBH implementation where Black patients receive their primary care is needed to maximize treatment possibilities among this group.

Introduction: Many patients with sore throat receive antibiotics from their general practitioners (GPs); however, only a minority are affected by bacterial infection, often streptococcal A (Strep A). Rapid diagnostic test can improve diagnosis, guide treatment decisions and direct patients when required for appropriate self-care. This study investigates the potential benefit of Strep A rapid tests in pharmacies for sore throat patients, with the aim of maximising healthcare resources.

Methods: Participants over 16 years old were screened using FeverPAIN scores, and those with high scores were tested for Strep A. To estimate avoided GP visits, participants completed a questionnaire on treatment choice (Accident & Emergency (A&E) GP visit, pharmacist, self-care) if the diagnostic service was unavailable.

Results and conclusion: Majority (86%) tested negative. The questionnaire revealed that 67% could avoid GP visits. When extrapolated to the UK, this could result in an estimated annual saving of £263 million for the National Health Service (NHS) Despite not being recommended for routine use by NICE, the study suggests that such rapid diagnostic testing for Strep A, combined with FeverPAIN screening, could prevent antimicrobial misuse, alleviate NHS pressure and empower pharmacists. This is particularly relevant considering the recent implementation of the pharmacy-first service.