BMC primary care最新文献

Background: Social prescribing aims to provide holistic care to patients and reduce health inequalities by meeting needs that expand beyond the biomedical model, as detailed in the National Health Service (NHS)'s Long Term Plan. While holistic care includes spiritual health, understanding of social prescribers' attitudes towards discussing spiritual health with their patients is limited. This study aimed to (1) explore social prescribers' views on discussing spiritual health with patients; and (2) identify key barriers and facilitators to incorporating spiritual health within their practice, including the potential for using a structured tool (the HOPE tool) to support discussions.

Method: We developed, piloted and administered a bespoke online survey for social prescribers working within primary care in the UK over two months, 1st August to 30th September 2024. This was based on our previous work with UK family doctors (general practitioners or GPs) on the topic of spiritual health and use of spiritual history-taking tools. The acceptability of the HOPE tool was investigated using patient vignettes drawn from clinical practice.

Results: One hundred seventy-one social prescribers responded. One hundred and twenty (70%) reported that they felt comfortable asking patients about their spiritual health. A similar proportion (71%) felt that the HOPE tool was beneficial. Those who were uncomfortable with the topic did not appear to have their comfort affected by learning about the HOPE tool. Attitudes towards spiritual health fell into categories of embracing, pragmatic, guarded and rejecting. Barriers and facilitators to discussion of spiritual health included: a perceived need for patient cues and training; fear of causing offence or upset; and pre-existing practitioner attitudes towards and/or interest in the topic.

Conclusions: Social prescribers are positive about discussing spiritual health with patients and feel comfortable with the topic. The HOPE tool may be helpful where social prescribers are already happy to discuss spiritual health, but other approaches will be needed for those who are reluctant to broach the topic. If social prescribers are more comfortable with the topic of spiritual health than GPs, they may hold the answer to an area of unmet need. Training needs are highlighted for further research.

Background: In the United States, approximately 25% of women experience attempted/ completed rape, and substantially more experience sexual assault, with minoritized women disproportionately. Survivors of sexual violence (SV) face higher odds of poor physical or mental health, leading to frequent interactions with healthcare systems. At the same time, survivors of SV may avoid care due to fear of re-traumatization, structural barriers, economic barriers, or fear and stigma. Despite high rates of medical mistrust (MM) among minoritized groups and previously identified associations between MM and health care avoidance, MM among SV survivors in this context has not been widely explored.

Methods: The THRIVE Study was a prospective case-control study of cisgender female past-month survivors of forced/threatened vaginal sex (rape) compared to consensually sexually active controls. Women completed three visits over three months, inclusive of surveys and biological sample collection. At baseline, participants were asked about past experiences of SV, including "sexual assault," past "forced/threatened sex" (not inclusive of past-month experiences), and recent "forced/threatened sex" (past month, assessed as eligibility criteria). Binary indicator variables were created for each experience. Using the Group-Based Medical Mistrust scale and sub-scales (discrimination, suspicion, lack of support), differences in MM were examined by SV history and self-identified race and ethnicity.

Results: Survivors of past or recent rape had significantly higher MM than others, with survivors of recent rape having the highest mean MM score (µ = 31.00, SD: 9.06 vs. µ = 25.89, SD: 9.41, p = 0.027; µ = 32.28, SD: 8.97 vs. µ = 25.86, SD: 9.15, p = 0.006). Survivors of past rape had significantly higher discrimination domain scores (p = 0.027), while recent survivors had significantly higher suspicion (p = 0.002) and lack of support scores (p = 0.039). Variation by SV experience and MM domain was identified among Latina, White, and Multiracial women. Black women had significantly higher MM than non-Black women (µ = 33.94, SD: 9.39 vs. µ = 26.35, SD: 9.00, p = 0.005), but no associations with SV history were identified.

Conclusions: Findings underscore the need for (a) patient-centered and trauma-informed care, with implementation of trainings or interventions to increase and knowledge to provide trauma-informed care, and (b) consistent, acceptable screening for experiences of violence across care settings, to inform provider interactions and responses.

Background: Understanding type 2 diabetes mellitus (T2DM) and its complexity is fundamental to achieving glycaemic control and preventing complications. This study aimed to assess people's diabetes knowledge in Primary Health Care Portugal context and explore sociodemographic and clinical data that may influence this knowledge.

Methods: A cross-sectional study of a descriptive nature was conducted between September 2022 and March 2023 through a convenience sample of 365 persons diagnosed with T2DM in primary care. The data were collected using the Diabetes Knowledge Test (DKT) and analyzed using descriptive, inferential, and bivariate statistics.

Results: Both people with T2DM not receiving insulin treatment (7.29; SD ± 1.99) and those receiving insulin treatment (11.98; SD ± 2.64) had an average level of knowledge and demonstrated more difficulties in areas such as diet, glycated hemoglobin (HbA1C) values, symptom management, and medication use (insulin). Some demographic factors that appear to be associated with better knowledge were younger age groups, higher education levels, and clinical data with lower HbA1c levels.

Conclusions: This study revealed that the knowledge of T2DM patients was average. Understanding the factors that can affect knowledge and the areas of knowledge that need to be explored further, such as diet, clinical value interpretation, symptom management, and medication, can help professionals develop specific interventions that contribute more effectively to better self-care behaviors, metabolic control, and fewer related complications. Additionally, living longer with a diagnosis is not an indicator of better knowledge of the disease, and special attention should be given to older people and those with lower education levels.

Background: Although the World Health Organization recommends the Health-Promoting School (HPS-WHO) as a fundamental strategy for health promotion, school-based public health programs grounded in implementation science are still rare, especially in socially vulnerable areas. Considering the co-creation process of the implementation foundations (i.e., logic model, LM) of new interventions is relevant to enhancing acceptability and sustainability in different contexts and resource conditions. We aimed to describe the co-create process of the LM of a school health-promoting program among public schools from socially vulnerable areas in a large municipality in Brazil.

Methods: This study followed the co-creation process of the program's LM considering three main stages: planning, conducting and evaluating, and final validation. The Program's LM was structured based on the Implementation Research LM (determinants, implementation strategies, mechanisms, and outcomes). The planning stage considered five strategies, using theoretical, evidence, and practice-based information. Stakeholders were invited by personal contacts, including researchers, teachers, managers, health professionals, undergraduate students, and recent school graduates. After the thematic analysis and consensus for the first version of the situational analysis and LM's elements, a second workshop was conducted. The final version of the Program's LM was validated by stakeholders who participated in the workshops and approved the version through consensus and scoring.

Results: Four HPS-WHO documents, ten systematic reviews on the implementation of HPS-WHO programs, a survey with 121 stakeholders, eight meetings with school managers, and a 2-h workshop with 17 stakeholders supported the development of the first version of the situational analysis with 35 themes and the Program's LM. The final version of the Program's LM and elements were approved by 13 stakeholders, with scores of 4.7 points or higher. The final LM included 15 determinants, four core strategies, three mechanisms, and three outcome domains.

Conclusions: After an interactive, multi-strategic, and multi-stakeholder process to co-create the LM, it may be used to guide the implementation and evaluation process of a public health program in all full-time public schools in the fifth most populous municipality in Brazil, in areas with very low Human Development Indexes. This highlights the essential role of cross-sectoral collaboration in strengthening primary health care through school-based strategies.

Background: Non-Communicable Diseases (NCDs) disproportionately affect marginalized populations, often due to delayed diagnosis and poor continuity of care. "Makkalai Thedi Maruthuvam" (MTM), a state-led initiative in Tamil Nadu, India, delivers home-based screening and care services for NCDs, aiming to overcome access barriers and promote equity. This study evaluates the program's performance in delivering NCD care across key steps of the care cascade.

Methods: A cross-sectional household survey was conducted across all 38 districts in Tamil Nadu, covering 6,856 adults aged ≥ 30 years through multi-stage cluster sampling. Data on screening, diagnosis, treatment, and control of diabetes, hypertension, and cancers were collected using handheld digital tools. Descriptive and inferential statistics were used to assess equity across gender, location, caste, and socioeconomic status.

Results: Screening coverage for diabetes and hypertension was 79.4% and 82.6%, respectively, with over two-thirds of services delivered by MTM field staff. While over 95% of diagnosed patients were on treatment, control rates remained low (9.8% for diabetes; 35.4% for hypertension). Cancer screening coverage was substantially lower, with notable disparities across caste and economic groups. Rural and SC/ST communities had greater program reach, but urban areas and male populations lagged. Approximately 30% of patients shifted from private to public care within one year.

Conclusion: MTM has significantly improved access to NCD care among marginalized populations through a community-based implementation model. However, challenges remain in ensuring equitable cancer screening, improving urban outreach, and achieving disease control. The study underscores the importance of community health workers and doorstep strategies in advancing health equity through primary care systems.

Background: Previous research has identified a need for relevant evidence-based clinical guidelines in primary care physiotherapy. However, an essential first step is to identify the most prevalent diagnoses among patients seeking physiotherapy. Thus, this study aims to (I) identify the most prevalent musculoskeletal diagnoses and, (II) describe physiotherapy utilization and patient characteristics among patients consulting physiotherapists in Swedish primary care.

Methods: This was a register-based study including all physiotherapy visits in primary care in Region Skåne, southern Sweden during 2023. Aggregated data on patient visits registered with diagnoses according to the ICD-10 classification system, chapter VIII, Diseases of the musculoskeletal system and connective tissue (M-codes), were retrieved from the Skåne Healthcare register and synthesized.

Results: Over the course of one year, 656,938 physiotherapy visits were registered, of which 34% (221,265) were first-time visits. Of those,176,317 (73%) had a registered M-diagnosis. Low back pain was the most common diagnosis (n = 13,833) followed by myalgia and cervicalgia. Spinal stenosis, fibromyalgia and osteoarthritis had the highest mean number of visits ranging from 4.2 to 4.8 visits per patient. Knee osteoarthritis had the highest estimated total number of visits (n = 31,390). Of the fifty most prevalent diagnoses, all but one had a higher proportion of women.

Conclusions: Although low back pain was the most common diagnosis, patients with knee osteoarthritis had the highest number of visits and thus utilized the most physiotherapy resources. This study provides a comprehensive overview of the 50 most common diagnoses which may aid in determining priority areas for the development of evidence-based clinical guidelines in physiotherapy primary care settings.

Background: Dutch GP-specialty training, like many Western European and U.S. postgraduate medical programs, emphasizes learning from role models and peers through reflection and openness to feedback. However, these methods depend on safe learning environments, which studies have indicated are often undermined for ethnic minority trainees due to microaggressions and exclusion experiences. Understanding their coping strategies and how they impact learning processes is crucial for promoting educational equity.

Research question: What coping strategies do ethnic minority GP trainees employ to balance the challenges of their educational environment with their personal backgrounds, and how could these strategies affect their ability to comply with learning processes required in GP-specialty training? With the following sub questions: What coping strategies do ethnic minority GP-trainees employ given the interplay between their learning environment and personal backgrounds? A How could utilizing these strategies affect these trainees' these learning processes?

Method: We conducted fourteen semi-structured, in-depth interviews with minority GP trainees, using purposive convenience sampling to ensure diversity across various dimensions. Through thematic analysis, we identified participants' coping strategies and learning processes with which they struggled.

Results: While strongly motivated to complete their GP-specialty training, participants faced prejudice and bias, leading them to adopt coping strategies-ranging from emotion-focused (religious support, compliance, detachment) to problem-focused (peer support, adaptation, identity balancing)-which notably shaped their abilities to adhere to learning processes required in their GP-specialty training (Table 3).

Conclusion: Ethnic minority GP trainees in the Netherlands face challenges that lead to coping mechanisms. While these strategies offer temporary relief, they can undermine connectedness and reflective thinking-both required in GP-specialty training. Consequently, these trainees often feel inclined to balance educational success with maintaining their well-being. We recommend further research into the challenges that drive these coping strategies among ethnic minority trainees to inform the development of inclusive learning environments.

Background: Scientific conferences reflect trends in Family Medicine research and education. In Germany, the annual congress program of the German Society of General Practice and Family Medicine (DEGAM) encompasses a wide range of topics and is publicly accessible. However, little is known about how research methodologies and topics evolve over time.

Methods: All program items from the DEGAM conferences from 2014 to 2024 were analyzed. Using the Large Language Model GPT-5, each item was automatically categorized by research methodology and topic. Descriptive statistics were used to summarize trends.

Results: A total of 2,869 program items were identified. Quantitative and interventional studies constituted 53.5% of all methodologies, while qualitative and mixed-methods accounted for 33.1%. The relative proportions remained largely unchanged over the eleven-year period, however future-oriented topics such as eHealth or sustainability do emerge. Although diverse topics were represented, they showed no clear methodological evolution in every topic.

Conclusions: This first exploratory analysis of a national Family Medicine conference series shows that, while the thematic range is broad, research methodologies remain stable. Therefore, as in patient care, academic Family Medicine is the 'decathlon' of health service research, too.

Background: The German healthcare system is confronted with a shortage of general practitioners (GPs) due to demographic changes and an aging workforce. Concepts such as team-based care, which ensure high-quality primary care, are necessary to address these future challenges. This study aimed to identify values as well as best practices of such team-based concepts.

Methods: We conducted n = 15 individual interviews with health professionals primarily working in primary care settings, including GP trainees, employed or self-employed GPs, medical assistants, primary care management or physician assistant students, and other health professionals (mean age = 36.13 years, 66.67% female). The interviews were transcribed verbatim and coded using a deductive category system based on prior research. For data analysis, we used qualitative content analysis following the framework method.

Results: Participants emphasized patient-centred and continuous care as core values of primary care, highlighting the importance of establishing trusting relationships through sufficient time with patients. In this context, they rated interprofessional team-based care as particularly beneficial for patients who are chronically ill and disadvantaged. The participants supported primary care models characterized by GP-centredness and gatekeeping, a high degree of digitalization, cooperation with non-physician health professionals, and well-defined roles within interprofessional teams. They also stressed the importance of remuneration and work-life balance. To evaluate future concepts of primary care, the interviewees recommended using both staff- and patient-reported measures, as well as operational metrics.

Conclusions: Our results indicate that the core values of primary care, such as patient-centredness and continuity of care, may be enhanced through interprofessional teamwork. While these values contribute to the intrinsic motivation of high-quality care, structural factors such as fair remuneration and digitalization are crucial for effective practice. To evaluate care models, the patient perspective, along with staff satisfaction and team performance, is regarded as an essential outcome measure.