BMC primary care最新文献

Background: Amid growing demands, workforce shortages, and rising costs, the evolving role of diagnostics-driven by technological innovation-underscores the urgent need to rethink the diagnostic process with stakeholders at the center. Knowledge on their perspectives on innovation of the diagnostic process is lacking, while it could ensure alignment with their needs and expectations.

Aim: To identify perspectives on innovation of the diagnostic process in general practice care.

Design and setting: Q-methodological study with stakeholders with different profiles but an informed opinion on the topic.

Method: Participants individually sorted 57 statements based on what they thought is most important for innovation of the diagnostic process in general practice care. Statements were collected from literature, media, and group meetings. Factor analyses identified different perspectives, which were subsequently holistically interpreted.

Results: We identified five perspectives: 1-innovation through diagnostic transformation, 2-innovation in communication, 3-innovation from a doctor-centered perspective, 4-system reform before innovation: fixing the foundation first, and 5-ambivalence towards innovation. The perspectives differed mostly in their urge for system change and the role for technology in innovation. In some perspectives, changes in the current or future diagnostic system were identified, whereas in others not. Also, the degree to which technology was deemed as the promising way forward differed between the perspectives.

Conclusion: This study gives insight into prevailing perspectives of stakeholders on innovation of the diagnostic process in general practice care. Each perspective offers valuable insights, as all are essential for successful innovation of the diagnostic process.

Background: Mental health disorders contribute significantly to the global disease burden. Integrating mental health services into primary health care (PHC) systems is a promising solution, with nurses playing a critical yet under-explored role due to their proximity to communities and holistic care approach. This study aimed to systematically review and synthesize qualitative and mixed-methods evidence.

Methods: A systematic review and meta-synthesis were conducted, adhering to PRISMA 2020 and ENTREQ guidelines. Six databases (PubMed/MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, Embase) were searched from inception to June 2025, supplemented by grey literature searches. Inclusion criteria, guided by the SPIDER framework, focused on qualitative and mixed-methods studies exploring nurses' roles in PHC mental health care. Study quality was assessed using the CASP Qualitative Checklist, and data were synthesized using thematic meta-synthesis, facilitated by NVivo 14.

Results: 34 studies from 18 countries were included, revealing four overarching themes: (1) Nurses' mitigation of multilevel stigma through empathy, education, and advocacy; (2) Challenges in navigating structural barriers, including resource scarcity, training gaps, workload pressures, and access inequities; (3) Adaptive psychosocial intervention practices using holistic assessments, empowerment strategies, technology, and cultural adaptations; and (4) Leadership in interprofessional patient-centered care through collaboration, trust-building, recovery-oriented frameworks, and systemic advocacy.

Conclusion: Nurses are instrumental in advancing mental health equity in PHC systems by addressing stigma, overcoming barriers, delivering tailored interventions, and leading collaborative care. Enhancing their impact requires mandatory mental health training, resource allocation, interprofessional frameworks, and further research in diverse global contexts.

Background: Team-based care is a primary care model that involves collaborative care between primary care providers and other professional providers. In Ontario Canada, this model is delivered through Community Health Centres. The study objective was to identify if visits to different providers within Community Health Centres were associated with fewer emergency department visits.

Methods: We conducted a retrospective population-based, nested case-control study using healthcare data at ICES. We included adults receiving primary care at a Community Health Centre in Ontario between 2016 and 2018 and captured the outcome of emergency department visits between 2019 and 2020. Using the Generalized Estimating Equation (GEE) extension of the negative binomial regression model, we estimated the association between number of visits to seven different provider types within a Community Health Centre and number of emergency department visits, with adjustment for potential confounders. We defined team-based care as a visit to one of the providers in a group other than a primary care physician or nurse practitioner (i.e., mental health, diet and lifestyle education, community workers/ lay patient support, physical therapy, health promotion system navigation, foot care). We also calculated the ratio of observed-to-expected average emergency department visits per person.

Results: We identified 138,324 patients across 71 Community Health Centres, with 43% who received team-based care. We found that increased number of visits to any provider was associated with more emergency department visits. However, there were no significant differences between observed and expected number of emergency department visits for people who received care from different providers.

Conclusions: Almost half of the adult Community Health Centre population received team-based care. Although some benefits of team-based care have been established in the literature, we did not find any associations between care received from individual team-based provider types with lower emergency department visits.