BMC primary care最新文献

Background: Lung ultrasonography (LUS) is a point-of-care imaging modality with growing potential in primary care.

Objectives: While its use is well established in hospital settings, data on its accuracy when performed by general practitioners (GPs) remain limited. This study aimed to assess the diagnostic accuracy of LUS conducted by GPs following structured training.

Methods: We recruited 17 GPs from various regions of the Czech Republic. They completed a two-day educational course focused on LUS. Patients with current dyspnoea (NYHA II-IV) or a history of dyspnoea within the last four weeks were included and underwent LUS to assess the presence of pleural effusion and interstitial syndrome. An independent expert sonographer, blinded to clinical data, evaluated recorded LUS video loops as the reference standard. LUS findings were categorized into A profile (presence of A lines and intact lung sliding, indicating normal aeration), B profile (three or more B lines per intercostal space in at least two intercostal spaces per hemithorax, suggesting interstitial syndrome), pulmonary consolidation and pleural effusion.

Results: A total of 128 patients were enrolled in the study. A total of 768 thoracic segments were examined. A profile was identified in 642 (83.6%) segments, B profile in 108 (14.1%), pulmonary consolidation in 8 (1.0%), and pleural effusion in 12 (1.6%). For the identification of A profile, the sensitivity was 97.51% (95% CI 95.98-98.57), and the specificity was 88.10% (95% CI 81,13-93,18); for B profile, the sensitivity was 87.04% (95% CI 79,21-92,73), and the specificity was 97.73% (95% CI96,28-98,72); for pulmonary consolidation, the sensitivity was 100.0% (95% CI 63,06-100,00), and the specificity was 100.0% (95% CI 99,52-100,0); for pleural effusion, the sensitivity was 83.33% (95% CI 51,59-97,91), and the specificity was 99.87% (95% CI 99,27-100,00).

Conclusion: Our findings provide important preliminary data, demonstrating that GPs can perform LUS accurately after a structured training program. THE TRIAL REGISTRATION IDENTIFIER: is NCT04905719.

Background: Mental health problems are an increasing challenge for primary healthcare. It puts strain on the healthcare professionals with limited time and resources. In several countries, healthcare professionals can refer patients with mental health issues to structured arts programmes, namely Arts on Prescription (AoP). This study explores the qualitative findings from a 3-year study on Arts on Prescription.

Methods: Primary healthcare patients were recruited to participated in a 10-week group-based arts programme, twice a week for 2 h (22 sessions over 10 weeks, comprising a mixture of arts and cultural activities facilitated by arts professionals) referred from 18 different primary healthcare centres. Twenty-eight participants volunteered to be interviewed using a semi-structured one-to-one approach. The transcribed interviews were analysed using a thematic analysis.

Results: Three themes were identified as Social community & Connectedness, Self-efficacy and Routine & Structure. Through the identified themes positive effects of psychosocial wellbeing is described as reported by the participants connecting to their experiences of participating in the Arts on Prescription programme including finding common grounds, feeling healthier and more human, connecting with inner resources, and establishing new routines.

Conclusions: The findings highlight the potential of Arts on Prescription programmes to promote holistic psychosocial wellbeing, and to facilitate personal growth through community engagement and structured arts activities with salutogenic approaches.

Background: Availability of information at the interface of outpatient and inpatient care remains an important and inadequately resolved issue in Germany and beyond. As a vulnerable group with complex care needs, older patients, mostly multimorbid, are especially affected by the consequences. This trial tested the feasibility and implementability of a complex intervention which aimed at improving the availability of health information among patients and different healthcare providers.

Methods: The prospective two-arm blinded pilot cRCT was accompanied by an explorative mixed-methods process evaluation. Over a period of six months in 2022, general practitioner (GP) practices in Germany with patients (≥ 65, multimorbid, polypharmacy) participated in testing the implementation of the intervention and the trial design (intervention (IG) vs control group (CG)). Here, the focus is on the feasibility and exploratory results of the primary (combined endpoint of hospitalisation, falls and mortality) and secondary outcome measures (improving GP practices' and patients' knowledge of health-related resource use (FIMA), as well as improving patients' Health Literacy (HLQ-G) and Satisfaction with Medication Information (SIMS-D)). Data were analysed according to the intention to treat principle.

Results: Twelve GP practices were randomised (6 per IG/CG). Of 159 patients invited, 93 were included in the analyses (52 IG/41 CG). At t0 and t1, only few self-reported data from patients (5 resp. 10) or from the GP questionnaire (resp. 0) were missing. At least one survey perspective was available for each patient at both survey times. Overall, there were few missing items in the questionnaires, so the scores could not be calculated in 4-18% of cases (primary combined endpoint 9%), and there were no single items with increased missing values (n = 0 to 7). The concordance of the hospitalisation data from patients and GP practices was about 80%. Exploratory analyses showed no effects of the intervention on primary or secondary outcome measures.

Conclusions: The primary combined endpoint was feasible. The secondary outcomes and survey methods used also proved feasible for GP practices and older multimorbid patients, with low missing rates. However, there was no hint of the influence of the intervention in the study groups in the explorative analyses.

Trial registration: The trial was registered in the DRKS German Clinical Trials Register: registration number DRKS00027649 (date: 19.01.2022); http://www.drks.de/DRKS00027649 .

Background: Self-monitoring of blood glucose (SMBG) is a low value health care practice that does not benefit most patients with non-insulin treated type 2 diabetes (T2DM). This paper evaluates Re-Think the Strip (RTS), a multi-component study aimed at de-implementing SMBG among non-insulin treated T2DM patients in primary care.

Methods: This study used a pre-post design to evaluate the effectiveness and implementation of Re-Think the Strip in 20 primary care clinics with a comparison group of 34 clinics within one health system. De-implementation strategies were implemented over 12 months and practices were followed for 18 months.

Results: There was an overall decrease in the odds of receiving a prescription for diabetes testing supplies (i.e., test strips and/or lancets) between the baseline and 12-month intervention follow-up for intervention and comparison clinics (OR 0.96, 95% CI 0.94, 0.98). However, there was no statistically significant difference in prescribing between the intervention and comparison clinics. In sensitivity analyses, a small intervention effect was observed for those patients newly diagnosed with T2DM or newly assigned to a study clinic (OR = 0.97, 95% CI 0.95, 1.00).

Conclusions: De-implementation strategies are feasible in primary care practices. Although prescriptions for SMBG decreased in intervention practices, they also decreased in the comparison practices. Newly diagnosed patients or new patients may be more receptive to de-implementation. Other factors, including the COVID-19 pandemic and baseline prescribing rates may have limited the effectiveness of the RTS de-implementation strategy.

Background: The COVID-19 pandemic has dramatically impacted healthcare systems worldwide, leading to changes in the delivery of healthcare services. A profound effect on the well-being of non-COVID-19 patients has been reported, but limited evidence is available from developing countries. This study aimed to describe the morbidity profiles of epidemiologically excluded COVID-19 patients during the pandemic in the primary care setting of the Anuradhapura District of Sri Lanka.

Methods: This cross-sectional healthcare institution-based study collected morbidity profiles from six state-owned and five private primary care facilities (PCFs) in the Anuradhapura District during the third wave of the COVID-19 pandemic. Reasons for Encounters (RFEs) were recorded from physically available and epidemiologically excluded COVID-19 patients in a paper-based data format and coded using the International Classification of Primary Care.

Results: Out of 1630 primary care encounters, 187 RFEs were identified. Most patients were females (n = 899, 55%) and in the adult age category (n = 1297, 79%). The median age of the patients was 39 years (interquartile range: 21-55). Older patients were likelier to seek primary care in the state sector (p < .001). Most children presented to the private sector compared to state PCFs (p < 0.001). The majority of females significantly utilised state sector PCFs (p = 0.043). Upper respiratory tract infections (n = 154, 9.00%) were the most common RFE. The highest burden of systemic RFEs was associated with dermatological (n = 294, 18%) and respiratory conditions (n = 274, 16%). More than one-third of adults (n = 487, 37.5%) suffered from a self-reported non-communicable disease (NCD). Hypertension (n = 235, 48%), diabetes mellitus (n = 184, 38%), and dyslipidemia (n = 134, 28%) were the most observed NCDs. Multimorbidity was reported in 195 (40%) adult patients with an NCD.

Conclusion: The pandemic has led to a shift in primary care morbidity profiles, with a higher incidence of dermatological and respiratory diseases and NCDs among healthcare seekers. Patients sought care from the state and private sector differently depending on age, sex, and nature of illness. Primary care services must prepare to adapt to changes in healthcare-seeking patterns and morbidity profiles during pandemics to ensure comprehensive care is available on demand.

Background: The infection rates with SARS-CoV 2 virus, known since 2019, are currently significantly weakened in their dynamics. Nevertheless, COVID 19 is still a common disease, which in most cases is overcome quite well and can be treated by the general practitioner. Despite an initially uncomplicated disease progression, the long-term consequences can be considerable. Symptoms persisting over a period of more than 12 weeks after infection are summarized as Post-COVID (PC) syndrome. The aim of this study is to document the symptom expression in PC patients in the outpatient setting, with a major focus on limitations in daily life and consequences for mental health.

Methods: This survey is part of a prospective European collaborative study with the German cohort having been slightly extended and evaluated separately. Data collection was performed by telephone interviews of adult SARS CoV 2 positive patients using standardized questionnaires (38 open and 6 closed questions). After an inclusion interview, follow-up interviews were conducted every 4 weeks over a period of 6 months. Participants were recruited in collaboration with the local health department (Wuerzburg, Germany).

Results: Sixty participants were recruited in April and May 2021. After 12 weeks (PC cutoff), 48.3% still reported symptoms related to SARS-CoV-2 infection. The most commonly reported symptoms were fatigue/tiredness (33.3%), reduced concentration (26.7%), and shortness of breath (23.3%). One-quarter of respondents reported impaired functioning, with the most common daily limitations being sports (28.3%), work (25.0%), and social life (15.0%). At 6 months, 21.6% of respondents experienced anxiety and 11.6% reported depressive symptoms. Overall, 40.0% of respondents were concerned that their health would deteriorate again or not fully normalize because of COVID-19. Over two-thirds (70.0%) visited a physician during the course of the study because of COVID-19, 73.8% of whom visited their general practitioner.

Conclusion: PC in outpatient care appears to be a complex and multifaceted condition that not only presents with physical symptoms, but also has a significant impact on mental health and daily life. Although the complexity of the condition is not yet fully understood, our findings suggest that it presents long-term challenges, particularly in outpatient care. Further research, particularly in larger and more diverse cohorts, is needed to confirm these observations. Routine screening for psychosocial comorbidities could be a valuable approach to identify supportive interventions that may help to reduce the risk of chronification and/or somatization.

Background: The shared perceptions and cognitions of a family toward health such as exercise are termed the family health climate (FHC), and they may influence individual physical activity levels. This study aimed to examine the associations between the FHC and physical activity and sedentary behaviour in adult patients with diabetes while accounting for sociodemographic factors and self-determined motivation.

Methods: This cross-sectional study was conducted at a polyclinic in Singapore. The participants completed anonymized, self-administered questionnaires that collected data on sociodemographic variables, family health climate for physical activity (FHC-PA), self-reported physical activity and sedentary behaviour (Global Physical Activity Questionnaire), and self-determined motivation (Behavioural Regulation in Exercise Questionnaire‑2). The data were analysed descriptively, and logistic regression was performed to examine the sociodemographic, FHC and motivational covariates of physical activity and sedentary behaviour.

Results: A total of 345 participants were included in the analysis. The majority were male (60.3%), Chinese (67.5%), and working (72.8%). The mean age was 61.56 (SD 10.71) years. A minority of the participants had sufficient physical activity (41.2%), and most were sedentary (62%). After we adjusted for sociodemographic factors and self-determined motivation, the FHC-PA score and its subdomains were not associated with physical activity levels (p > 0.05) or sedentary behaviour (p > 0.05). Those with higher identified regulation scores had higher odds of being sufficiently active, whereas those with higher external regulation scores, from larger households and who were employed had lower odds of sufficient physical activity. Higher degrees of autonomous motivation were associated with reduced sedentary behaviour, whereas being employed was associated with increased sedentary behaviour.

Conclusion: The FHC-PA, in the presence of self-determined motivation and sociodemographic factors, was not associated with the individual physical activity levels of adults with diabetes. Further studies can be conducted to determine whether it plays a mediating role. As identified regulation was associated with both physical activity and sedentary behaviour, interventions can be mapped to target this motivational domain.

Background: There is a scarcity of research about patients' perspectives on the role of general practice pharmacists (GPPs). In this review, we aimed to compile qualitative evidence of patients' perspectives regarding the role of GPPs.

Methods: A systematic, qualitative meta-synthesis was undertaken. A comprehensive search was conducted on six databases. Additionally, the reference lists of included studies were searched. Findings and verbatim quotes were extracted from the included studies and were analysed using thematic synthesis. The Critical Appraisal Skills Programme (CASP) checklist was employed to evaluate the quality of the included studies. The GRADE-CERQual approach was utilised to evaluate confidence in the findings.

Results: Ten qualitative studies were included. Four main themes were identified: awareness of the GPP (patients were unaware of the GPP's role), accessibility to the GPP (some patients had difficulties arranging appointments with GPPs), benefits and challenges (medication review conducted by GPPs reaffirmed patients' trust in taking their medicines, although some were dissatisfied with the medication review process), and GPP integration into general practice (successful integration of GPPs was attributed to their skills and teamwork). The included studies satisfied all or at least seven out of the ten criteria of the CASP checklist. GRADE-CERQual indicated high confidence for one theme, and moderate confidence for three themes.

Conclusions: This systematic review and meta-synthesis of qualitative studies provides valuable insights into patients' perspectives on the role of GPPs. The findings highlight both positive aspects and challenges associated with GPP integration into primary care, including concerns about role awareness and accessibility. These findings suggest that while GPPs can add value to general practice teams, there is a need for improved patient education about the GPP role and enhanced accessibility to maximise the potential benefits of the GPPs.

Clinical trial number: Not applicable.