BMC primary care最新文献

Background: Burnout in healthcare workers results in higher staff turnover and poorer patient care. Knowledge of burnout and its associated factors among polyclinics' (public primary care clinics) healthcare workers in Singapore is lacking. This study aims to evaluate the extent of burnout and identify associated factors in polyclinic staff.

Methods: This was a cross-sectional study conducted in Singapore's National University Polyclinics. From 11 July to 4 September 2024, an anonymous self-administered online questionnaire was sent to eligible doctors, nurses, and allied health staff. The Maslach Burnout Inventory Human Services Survey (MBI-HSS) with domains of emotional exhaustion, depersonalisation, and personal accomplishment was used to measure extent of burnout and tested for associations with staffs' demographics, working-related factors, patient-related experiences, lifestyle, resilience levels (measured by the Brief Resilience Scale), and intention to quit using multivariable linear regression.

Results: Of the 228 participants, 82 were doctors, 79 were nurses, and 67 were allied health. Mean total MBI-HSS scores were 25.98 (SD = 12.40, min-max = 1-53) for emotional exhaustion, 10.22 (SD = 7.24, min-max = 0-30) for depersonalisation, and 31.69 (SD = 8.33, min-max = 8-48) for personal accomplishment. Emotional exhaustion was associated with being a doctor (B = 4.55, SE = 1.60, p = 0.005) and nurse (B=-4.16, SE = 1.70, p = 0.015) compared to allied health workers. Emotional exhaustion was also associated with fewer average hours of exercise a week (B=-0.51, SE = 0.22, p = 0.024), and lower levels of resilience (B=-4.44, SE = 1.12, p < 0.001). Depersonalisation was associated with being a doctor (B = 2.56, SE = 0.97, p = 0.009) and perception of less recognition by patients (verbally or in writing) (B=-6.25, SE = 2.56, p = 0.016 for neutral; B=-8.99, SE = 2.54, p < 0.001 for agree; B=-8.69, SE = 2.82, p = 0.002 for strongly agree). Personal accomplishment was associated with being male (B = 3.38, SE = 1.37, p = 0.015), having full-time domestic help (B = 3.12, SE = 1.17, p = 0.008), being a member of a teamlet (B = 3.02, SE = 1.33, p = 0.024), perceiving greater recognition by patients (B = 8.60, SE = 3.21, p = 0.008 for agree; B = 12.46, SE = 3.55, p < 0.001 for strongly agree), and higher levels of resilience (B = 0.60, SE = 0.13, p < 0.001).

Conclusions: The study highlighted the extent of burnout in healthcare workers in Singapore's public primary care and its associated factors. Strategies that could potentially manage burnout include improving patient-provider relationships, improving work environment, increasing resilience in healthcare workers, and optimising team-based care models.

Background: Family Medicine (FM) core values shape clinical practice, medical education, policy, and research. While universally recognised FM principles exist, their interpretation and implementation may vary significantly across different contexts, countries and time.

Methods: This scoping review systematically examined literature from diverse international sources to identify and analyse the evolving core values of FM. Relevant studies were reviewed to determine common themes, variations, contextual influences shaping FM and emerging themes.

Results: Twenty-one studies were included. Core values such as person-centred care, continuity, comprehensiveness, and coordination featured prominently across the literature. Although these traditional values persisted, their interpretations and prioritisations varied significantly according to geopolitical and healthcare system structures. Regional differences reflected local workforce structures, healthcare challenges, and sociopolitical context. High-income regions emphasised values like relational care, stewardship, and advocacy reflecting evolving expectations towards social responsiveness. Lower-resourced areas prioritised accessibility, procedural competence, and team-based leadership, responding pragmatically to infrastructural constraints. Over time, new values such as sustainability, comfort with complexity, and social accountability have emerged, indicating global concern for equity, physician well-being and proactive public engagement.

Discussion: This review highlights a dynamic landscape of FM values, shaped by both universal principles and local adaptation. As countries refine their health systems and FM roles, there is a need for value frameworks that are both globally informed and locally grounded. Clear articulation of values will guide education, policy, research, and professional identity, ensuring that FM remains responsive and relevant amidst evolving healthcare landscapes.

Background: General practitioners (GPs) should regularly review patients' medications and, when they are potentially harmful or no longer necessary, implement deprescribing approach. We aimed to assess the perceptions and potential barriers to deprescribing among Italian GPs.

Methods: GPs were invited to participate in an observational cross-sectional study through an online survey containing 20 questions addressing attitudes towards deprescribing, including physicians' perceptions, potential barriers, and how this process is addressed in daily clinical practice. The survey, accessible for responses from 4th May 2023 to 15th January 2024, was distributed through social media, networks, medical associations, and involving primary care departments of local health authorities.

Results: Over 8 months, 617 answers were collected. Less than 2% (n = 11) reported to not implement deprescribing interventions in daily practice, primarily due to perceived insufficient experience (n = 7) or lack of specific education (n = 6). Conversely, 23.1%(n = 142) of respondents reported frequently or very frequently implementing deprescribing. Among barriers, GPs reported difficulties in dealing with specialists (n = 438, 71.7%), distrust of patients in drug discontinuation (n = 326, 53.4%), poor availability of deprescribing guidelines (n = 231, 37.8%), and time constraints (n = 213, 34.9%). Guidelines and targeted training were mostly demanded (by 66.1% and 59.6%, respectively). Regarding specific drug classes, the proportion of GPs reporting to frequently implement deprescribing for proton pump inhibitors was 51.8% (n = 313), while percentage was lower for benzodiazepines (n = 166, 27.4%), bisphosphonates (n = 147, 24.3%), statins (n = 128, 21.2%), antihypertensives (n = 108, 17.9%), and antidepressants (n = 96, 15.9%).

Conclusion: The study shows that while GPs recognize the importance of deprescribing, however, they face significant barriers, including a lack in targeted education and specific guidelines to enhance their confidence and knowledge in implementing this process effectively in daily clinical practice.

Background: Healthcare professionals working in primary care are well positioned to provide initial physical activity counseling owing to their frequent patient contact and their role as a trusted source of health information. Unfortunately, despite health benefits and recommendations, physical activity assessment and promotion in primary care settings is not a routine practice. Because there are currently no standardized practices, it is essential to know what practices are currently employed and explore the barriers to their use. The aim of this study is twofold: first, to describe and compare the practices used by primary care healthcare professionals regarding physical activity assessment and promotion among chronic disease patients and second, to explore the barriers to their use.

Methods: A cross-sectional survey was conducted among primary care healthcare professionals. The questionnaire designed for this project on physical activity assessment and promotion practices was sent electronically to all 619 primary care healthcare professionals in the Mauricie and Centre-du-Quebec regions. Each item was evaluated with a 5-point Likert scale. Descriptive statistics were used to describe sociodemographic characteristics as well as physical activity assessment and promotion practices. Group comparisons were performed according to professionals' roles.

Results: Sixty-eight (11%) of the healthcare professionals responded to the questionnaire. Both physical activity assessment and promotion practices were reported at similar levels, with mean scores of 3.79 ± 1.05 and 3.69 ± 0.78, respectively, on a 5-point Likert scale. A few specific tools and methods are used by healthcare professionals to assess and promote physical activity. The main barriers to physical activity assessment and promotion during clinical consultation were patients' perceived lack of interest in physical activity and professionals' lack of knowledge regarding PA guidelines, tools and methods, and contraindications.

Conclusions: Overall, primary care healthcare professionals are convinced of the benefits of physical activity in preventing and treating chronic diseases and recognize they have an important role to play. Although committed to promoting physical activity among chronic disease patients, they require continuous training on guidelines, validated tools, and motivational interviews together with clear advice to properly implement physical activity assessment and promotion practices.

Background: Although most UK National Health Service (NHS) consultations take place in primary care, healthcare research is dominated by secondary care and higher education institutions. The Royal College of General Practitioners has called for increased academic activity by developing research capability in General Practice. However, little is known about the challenges for GPs involved in research. We aimed to explore general practitioners' (GPs) experiences of using a screening tool embedded in a research study.

Method: We recruited GPs from three practises participating in the study. An independent researcher interviewed GPs virtually. The interviews were recorded, transcribed verbatim, checked against recordings, and de-identified. We used Reflexive Thematic Analysis to develop essential themes.

Results: We developed four themes giving insight into barriers to research activity: (1) it's rare that things are black or white, (2) it's a clinical tool, not a clinician, (3) it's about balancing valuable time, (4) we don't see every patient face-to-face anymore.

Conclusion: Quantitative research design, underpinned by positivist epistemology does not always align with primary care practice. Our findings highlight competing epistemologies that can make it challenging for GPs to complete standardised measures in a primary care setting. General practice involves a complex reasoning process grounded on interpretive knowledge. Closed questioning does not always comfortably align with a primary care setting where "a simple answer" is rare. Compatibility with primary care should be considered in all research design.

Background: While risk-stratified heart failure screening demonstrates clinical value in enabling early intervention, current implementation remains limited globally. This study aims to develop and validate a multi-stakeholder collaborative screening framework based on primary healthcare system.

Methods: We conducted the Pudong Heart Failure Screening Project (PHSP) in the medical consortium in Shanghai. The PHSP was delivered via five phases: (a) investigation, (b) screening, (c) individual invitation, (d) consultation in primary health care and (e) management in secondary health care. Data were collected by electronic data capture (EDC) system, office administrators and GPs. Univariate and multivariate logistic regression analysis was used to examine the relationship between the outcomes and factors.

Results: A total of 8022 individuals took part in the PHSP and 2473 participants (30.83%) were initially defined positive in the screening. Among the 2473 positive participants, 1553 responded to the invitation call, and 664 individuals accepted the invitation to visit the Cardiologist-driven GP joint clinic. Notably, house price was identified as a significant factor influencing their decision to accept the invitation (OR = 7.598, 95%CI (1.717-33.621), p < 0.05). Finally, a total of 563 patients visited the clinic and 307 positive individuals visited the secondary care institution. The use of an AI-assisted referral system significantly increased attendance at secondary care (OR = 11.4). The cost of the screening program was 12.25 US per individual screened and 39.73 US per positive individual identified.

Conclusions: PHSP identified older adults at early risk of heart failure through low-cost community screening. The collaboration of multiple parties ensured the full implementation of the screening project and it was a typical practice case in the realm of implementation science worthy of promotion in more regions.

Trial registration: The study was retrospectively registered in https://www.

Clinicaltrials: gov/ , trial registration number: NCT06673615, and data of registration: September 23, 2024.