BMC primary care最新文献

Background: General practice data holds significant potential for secondary use in research, offering insights into healthcare delivery, disease patterns, and informing policy development. However, the ethical, practical, and relational complexities of data sharing in general practice settings remain underexplored. This scoping review investigates the perspectives of general practice staff-including general practitioners, practice nurses, and practice managers-on sharing general practice data for research purposes.

Methods: The review followed the JBI methodology for scoping reviews and adhered to PRISMA-ScR guidelines. A comprehensive search of MEDLINE, Scopus, PsycINFO, and grey literature sources was conducted, with studies selected based on predefined inclusion criteria. Nine studies from Australia and the United Kingdom were included. Data were extracted and analysed using narrative synthesis to identify key themes and gaps in the literature.

Results: General practice staff broadly supported data sharing for research, citing public benefit and improved healthcare outcomes. However, support was conditional on robust privacy protections, ethical governance, and practical support. Key concerns included patient privacy, commercialisation, trust, consent models, and operational burden. Views on consent were polarised, with preferences varying between opt-in, opt-out, and waiver models. Notably, none of the included studies addressed the perspectives of vulnerable population groups, representing a significant gap in the literature.

Conclusion: General practice staff are willing to share data for research if ethical and practical safeguards are in place. Future initiatives must prioritise transparency, trust, and inclusivity-particularly by addressing the needs of vulnerable populations-to ensure equitable and sustainable data sharing practices.

Background: Women's sexual and reproductive health care in England is fragmented, with multiple providers, access inequalities, and commissioning barriers. In some areas health leaders, often based in primary care settings, have established 'Women's Health Hubs' to improve care and outcomes. The 2022 English Women's Health Strategy subsequently recommended national implementation of these models. This study aimed to explore Women's Health Hubs established before 2022 to inform national policy and practice: to describe models, explore experiences of implementation, delivery and care, key features and indicators of success.

Method: Mixed-methods evaluation included an online survey of identified UK hub leaders to identify and describe models and interviews with English regional and national stakeholders (n = 13). In-depth work in four purposively selected hubs included interviews with staff working in or connected to the hub (n = 40), women using hubs (n = 32), focus groups with underserved women in the local community (n = 48), and analysis of documents shared by hubs.

Results: Seventeen UK hubs were identified (13 in England). Hubs were diverse in size, maturity, commissioning and delivery models. Primary care leadership and settings predominated. Common services included long-acting reversible contraception and menopause care. Data availability limited the assessment of impact on health and inequalities, though there were examples of short waiting times, improved access to long-acting reversible contraception, and reduced secondary care referral in individual hubs. Women using hubs reported positive experiences. A need for equality in access and avoiding destabilising existing services was emphasised. Hubs were described as potentially improving primary care staff retention. Challenges included fragmented commissioning, workforce shortages, funding, and poorly-integrated infrastructure, including electronic patient records. Perspectives varied regarding the optimal model and leadership, including the role of primary care.

Conclusions: Women's Health Hubs have potential to integrate and improve women's care, though there are ongoing challenges in defining and implementing these models. Heterogeneity in models makes extrapolating conclusions difficult. Further evidence is needed of the impact on inequalities, population health and on the wider health system, including unintended or adverse consequences. Tailoring to local context is important. Sustainable national scale-up across England will require funding and time, and primary care professionals and organisations will be central to success.

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: 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: 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.