Journal of Primary Care and Community Health最新文献

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.

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.

This study conducted a validation of the piloted Positive Psychology Intervention (PPI) program, which was empirically designed based on the character strengths and virtues (CSV) of the Person Who Use Drugs (PWUDs) and aims to improve their life satisfaction, mental wellbeing, and overall psychological functioning. Forty male residents of the Mega Drug Abuse Treatment and Rehabilitation Center were randomly assigned in treatment or control group using a between-subject experimental pretest-posttest design. Results showed significant improvement in PWUDs' mental wellbeing (M = -0.63, SD = 0.25; t(20) = -2.5, P < .02921), overall psychological functioning (M = -1.25, SD = 0.22; t(20) = -5.71, P < .00013) but not in their life satisfaction (M = -1.55, SD = 0.4; t(20) = -1.55, P > .15033); this could be attributed to their habituated lifestyle brought by their prolonged stay in the center due to the series of nationwide restrictions. However, the vibrant documented accounts of the PWUDs about the perceived impact of the PPI program showed a very high rating coupled with substantial data supporting impactful effects on their overall personhood that are essential to their drug abuse treatment and rehabilitation efforts. Putting the data altogether, it is validated that the PPI program was practical, effective, and functionally responsive to the drug abuse treatment and rehabilitation of the PWUDs. Pertinent conclusions were drawn, and recommendations were provided accordingly.

Background: Chronic musculoskeletal pain is a major health issue worldwide, characterized by a significant disease burden that leads to disability and reduced quality of life. Its prevalence is increasing, particularly among the aging population. Research is needed to provide effective, individualized, and theory-based eHealth self-management interventions to improve clinical outcomes, and access to care. There is a lack of consensus in the literature on the concept of eHealth self-management support for chronic musculoskeletal pain.

Objective: The aim of this study is to conduct a concept analysis of eHealth self-management support for chronic pain within the framework of the Social Cognitive Theory.

Methods: Our study was guided by Mckenna's 9-step process for concept analysis as a framework: (1) Select the concept; (2) Determine the purpose of the analysis; (3) Identify the uses; (4) Determine attributes; (5) Identify a 'model case'; (6) Identify alternative cases; (7) Identify antecedents and consequences; (8) Consider context and values; and (9) Identify empirical indicators. We searched the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ovid MEDLINE, Web of Science, and other sources between 2000 and 2025. Studies were included if they met the predetermined inclusion and exclusion criteria.

Results: A total of 12 studies were included to define the main attributes, antecedents, and consequences. The attributes were: (1) Person-centered, accessible, personal, and facilitated behavioral change; (2) Web-based multidisciplinary education, modeling, and vicarious learning; (3) Web-based goal setting, activity planning, self-monitoring, and automated personalized feedback for motivational enhancement; and (4) Web-based social support and communication with healthcare providers.

Conclusion: This study has delineated the concept of eHealth self-management support for chronic pain and provided a foundation for future research.

Purpose: To examine whether primary care visit frequency (PVF) is associated with non-urgent emergency department visits (NU-EDVs) at a large urban medical center, and to identify determinants of higher PVF among Emergency Department patients.

Methods: We conducted a cross-sectional survey of adult ED patients (ESI ≥4 considered NU-EDV) at a Southern California Level I trauma center (September 2021-April 2024). Undergraduate research associates administered a 29-item instrument capturing demographics, utilization, barriers, trust in primary care, and comorbidities. Bivariate tests and multivariable logistic regression estimated adjusted odds ratios (aOR) for NU-EDV and for PVF ≥3 visits/year.

Results: Among 964 patients with a primary care provider, 62.9% reported <3 PCP visits/year; 59.2% presented with NU-EDV. After adjustment, PVF ≥3/year was associated with lower odds of NU-EDV (aOR 0.64, 95% CI 0.48-0.87). Medicaid/Cal insurance was associated with higher odds of NU-EDV versus private insurance (aOR 1.53, 95% CI 1.12-2.08). Determinants of PVF ≥3/year included female sex (aOR 1.39, 95% CI 1.04-1.86), older age (aOR 1.01 per year, 95% CI 1.00-1.02), Black race (aOR 2.21, 95% CI 1.17-4.19), Medicaid/Cal coverage (aOR 1.70, 95% CI 1.22-2.37), more chronic conditions (aOR 1.53 per condition, 95% CI 1.35-1.71), and lower odds with PCP distrust (aOR 0.54, 95% CI 0.30-0.96).

Conclusions: Greater primary care engagement is independently associated with fewer NU-EDVs; however, Medicaid beneficiaries remain at elevated risk for non-urgent ED use. Improving after-hours access, care coordination, and Medicaid-eligible unscheduled primary care may further reduce avoidable ED utilization.

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.

Introduction: Screening for osteoporosis is mainly done by measuring bone mineral density using dual-energy X-ray absorptiometry (DXA) scan. Screening does not usually start until 65 years. Many people 50 to 65 years may unknowingly suffer from progressive bone loss and may be at risk of osteoporosis. Opportunistic use of chest X-rays obtained for other indications could potentially be used to identify patients with signs of bone demineralization and at risk of osteoporosis in primary care settings particularly where DXA may not be readily available. We aimed at comparing the prevalence of bone demineralization using chest radiographs obtained for any indication in patients 50 to 65 years seen at an emergency department, as assessed from their radiology reports and by independent review by a radiologist. We also sought to explore clinical and demographic associates of low bone mass (LBM) among this population.

Methods: We conducted a cross-sectional review of electronic medical records of patients 50 to 65 years, who had obtained a chest X-ray at the emergency department of a large Level 1 trauma center in an urban teaching hospital between May 1, 2021, and May 31, 2021. We estimated the prevalence of "bone demineralization" from the X-rays reports and compared it with that obtained by an independent radiologist's review. We also used the 2020 US population census figures to estimate the number of people 50 to 65 years potentially at risk of LBM and investigated demographic and clinical correlates of LBM.

Results: We reviewed 390 patient records, comprising 201 (51.5%) males and 189 (48.5%) females. Bone demineralization comment was found in 4 (1.0%) reports while radiologist review found 49 (12.6%). Applying sex-adjusted prevalence of 13.1% (using the direct method, with the 2020 US population as standard) to the 64.1 million adults 50 to 64 years in the US population, we estimated that approximately 8.4 million people will have bone demineralization in the population group. LBM was associated with hypertension in women (OR = 2.41, 95% CI = 1.03-5.64).

Conclusion: Use of opportunistic chest X-rays may be feasible in identifying patients at risk of bone loss outside the traditional screening age particularly in areas where DXA may not be readily available.