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Hypertension and diabetes control: faith-based centres offer a promise for expanding screening services and linkage to care in Ghana. 高血压和糖尿病控制:信仰中心为加纳扩大筛查服务和联系护理提供了希望。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-24 DOI: 10.1186/s12875-024-02620-0
Engelbert A Nonterah, Samuel T Chatio, Andy Willis, Joseph A Alale, Sawudatu Zakariah-Akoto, Natalie Darko, Ffion Curtis, Setor K Kunutsor, Ceri Jones, Samuel Seidu, Patrick O Ansah

Background: Hypertension and type 2 diabetes mellitus (T2DM) are important contributors to noncommunicable disease related morbidity and mortality. Health systems could benefit from exploring the use of Faith-Based Centres (FBC) to screen and link suspected cases for further care in order to help achieve Sustainable Development Goal (SDG) 3. The study investigated the role of faith-based screening for T2DM and hypertension and the linkage of cases to the healthcare system and examined the care cascade in the Kassena Nankana Districts of Northern Ghana.

Methods: We screened individuals from 6 FBCs for elevated blood pressure and hyperglycaemia. Suspected hypertension and T2DM cases were referred to health facilities for confirmation and subsequently followed them up for 3 months. We assessed the prevalence of behavioural and metabolic risk factors, including hypertension and T2DM, and the retention of referred cases in the healthcare system over follow up period. We further assessed levels of awareness, treatment and adequate control of hypertension and T2DM.

Results: A total of 631 participants were screened, (mean age 49 ± 16years, 73% female) from 6 Faith based Centres. More males than females reported smoking tobacco (14.5% vs. 0.7%) and been physically active (64.5% vs. 52.7%) while more females were obese (29.6 kg/m2 vs. 14.5 kg/m2) and had a higher mean waist circumference (89.0 cm IQR 75-116 cm vs. 84.2 cm IQR 72-107 cm), hip circumference (101.5 ± 10.6 cm vs. 96.4 ± 8.6 cm) and waist-to-hip ratio (0.86 ± 0.1 cm vs. 0.87 ± 0.1 cm) than males. The prevalence of confirmed hypertension and T2DM was 27.9% and 3.5% respectively with no observed sex differences. We observed deficits in the hypertension and T2DM care cascade with reported low awareness, treatment and uncontrolled levels. A 3-month follow up showed a retention in care of 100% in month one and 94.9% in the third month. There was an increase in treatment (39.4% in month-1 and 82.8% in month-3) and control (26.3% in month-1 and 76.3% in month-3) of hypertension and T2DM combined.

Conclusion: Faith-based centres have the potential to enhance the screening, linkage to the healthcare system, and management of hypertension and T2DM. This improvement over the routine system could lead to earlier diagnoses, a reduction in complications, and decreased premature mortality from cardiovascular diseases. Consequently, these efforts would contribute significantly to achieving SDG 3.

背景:高血压和 2 型糖尿病 (T2DM) 是导致非传染性疾病相关发病率和死亡率的重要因素。探索利用信仰中心(FBC)筛查疑似病例并将其与进一步治疗联系起来,有助于实现可持续发展目标(SDG)3,从而使医疗系统从中受益。 本研究调查了信仰中心筛查 T2DM 和高血压的作用,以及将病例与医疗系统联系起来的情况,并考察了加纳北部卡塞纳-南卡纳地区的级联护理:我们对 6 个宗教中心的个人进行了血压升高和高血糖筛查。疑似高血压和 T2DM 病例被转诊到医疗机构进行确诊,随后对他们进行了为期 3 个月的随访。我们评估了行为和代谢风险因素(包括高血压和 T2DM)的流行情况,以及在随访期间转诊病例在医疗系统中的保留情况。我们还进一步评估了对高血压和 T2DM 的认识、治疗和适当控制水平:共有来自 6 个信仰中心的 631 名参与者接受了筛查(平均年龄为 49 ± 16 岁,73% 为女性)。报告吸烟(14.5% 对 0.7%)和参加体育锻炼(64.5% 对 52.7%)的男性多于女性,而肥胖(29.6 kg/m2 对 14.5 kg/m2)和平均腰围(89.0 cm IQR 75-116 cm vs. 84.2 cm IQR 72-107 cm)、臀围(101.5 ± 10.6 cm vs. 96.4 ± 8.6 cm)和腰臀比(0.86 ± 0.1 cm vs. 0.87 ± 0.1 cm)均高于男性。确诊的高血压和 T2DM 患病率分别为 27.9% 和 3.5%,没有观察到性别差异。我们观察到高血压和 T2DM 护理流程中存在缺陷,据报告,患者对高血压和 T2DM 的认识不足,治疗和控制水平不高。为期 3 个月的随访显示,第一个月的护理保留率为 100%,第三个月为 94.9%。高血压和 T2DM 的治疗率(第 1 个月为 39.4%,第 3 个月为 82.8%)和控制率(第 1 个月为 26.3%,第 3 个月为 76.3%)均有所提高:结论:信仰中心有潜力加强高血压和 T2DM 的筛查、与医疗系统的联系和管理。与常规系统相比,这种改进可能导致更早的诊断、并发症的减少以及心血管疾病导致的过早死亡。因此,这些努力将大大有助于实现可持续发展目标 3。
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引用次数: 0
Redesigning telemedicine: preliminary findings from an innovative assisted telemedicine healthcare model. 重新设计远程医疗:创新型辅助远程医疗保健模式的初步发现。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-23 DOI: 10.1186/s12875-024-02631-x
Arun Pulikkottil Jose, Aprajita Kaushik, Huibert Tange, Trudy van der Weijden, Nikki Pandey, Anshika Sharma, Ruksar Sheikh, Nazneen Ali, Savitesh Kushwaha, Dimple Kondal, Abhishek Chaturvedi, Dorairaj Prabhakaran

Background: Telemedicine holds immense potential to revolutionise healthcare delivery, particularly in resource-limited settings and for patients with chronic diseases. Despite proven benefits and policy reforms, the use of telemedicine remains low due to several patient, technology, and system-level barriers. Assisted telemedicine employs trained health professionals to connect patients with physicians, which can improve access and scope of telemedicine. The study aims to describe the design, service utilisation and chronic disease outcomes following the implementation of an assisted telemedicine initiative.

Methods: This is an observational implementation study. Barriers and potential solutions to the implementation of telemedicine were identified through interviews with key stakeholders. The assisted telemedicine solution using an interoperable platform integrating electronic health records, point-of-care diagnostics, and electronic clinical decision support systems was designed and piloted at three telemedicine clinics in Tamil Nadu, India. Nurses were trained in platform use and facilitation of tele-consultations. Health records of all patients from March 2021 to June 2023 were included in the analysis. Data were analysed to assess the utilisation of clinic services and improvements in health outcomes in patients with diabetes mellitus and hypertension.

Results: Over 2.4 years, 11,388 patients with a mean age of 45 (± 20) years and median age of 48 years, predominantly female (59.3%), accessed the clinics. The team completed 15,437 lab investigations and 26,998 consultations. Among 5542 (48.6%) patients that reported chronic conditions, diabetes mellitus (61%) and hypertension (45%) were the most frequent. In patients with diabetes mellitus and hypertension, 43% and 75.3% were newly diagnosed, respectively. Diabetes mellitus and hypertension patients had significant reductions in fasting blood sugar (-33.0 mg/dL (95% CI (-42.4, -23.7, P < 0.001)), and systolic (-9.6 mmHg (95% CI (-12.1, -7.0), P < 0.0001)) and diastolic blood pressure (-5.5 mmHg (95% CI (-7.0, -4.08), P < 0.0001)) at nine months from first visit, respectively.

Conclusions: The 'Digisahayam' model demonstrated feasibility in enhancing healthcare accessibility and quality by bridging healthcare gaps, diagnosing chronic conditions, and improving patient outcomes. The model presents a scalable and sustainable approach to revolutionising patient care and achieving digital health equity, with the potential for adaptation in similar settings worldwide.

背景:远程医疗在彻底改变医疗服务方面具有巨大的潜力,尤其是在资源有限的环境中和对慢性病患者而言。尽管远程医疗的好处已得到证实,政策也进行了改革,但由于患者、技术和系统层面的障碍,远程医疗的使用率仍然很低。辅助远程医疗采用训练有素的医疗专业人员将患者与医生连接起来,可以提高远程医疗的可及性和范围。本研究旨在描述辅助远程医疗计划实施后的设计、服务利用率和慢性病治疗效果:这是一项观察性实施研究。通过对主要利益相关者的访谈,确定了实施远程医疗的障碍和潜在解决方案。在印度泰米尔纳德邦的三家远程医疗诊所设计并试行了使用可互操作平台的辅助远程医疗解决方案,该平台集成了电子健康记录、护理点诊断和电子临床决策支持系统。护士接受了平台使用和促进远程会诊方面的培训。2021 年 3 月至 2023 年 6 月期间所有患者的健康记录均纳入分析范围。对数据进行分析,以评估糖尿病和高血压患者对诊所服务的利用率和健康状况的改善情况:在 2.4 年的时间里,共有 11,388 名患者到诊所就诊,平均年龄为 45(± 20)岁,中位年龄为 48 岁,以女性为主(59.3%)。团队完成了 15437 次实验室检查和 26998 次咨询。在 5542 名(48.6%)报告患有慢性病的患者中,糖尿病(61%)和高血压(45%)最常见。在糖尿病和高血压患者中,分别有 43% 和 75.3% 是新确诊的。Digisahayam "模式通过缩小医疗差距、诊断慢性病和改善患者预后,证明了提高医疗服务可及性和质量的可行性。该模式提供了一种可扩展、可持续的方法来彻底改变患者护理和实现数字医疗公平,并有可能在全球类似环境中进行调整。
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引用次数: 0
What helps or hinders intervention success in primary care? Qualitative findings with older adults and primary care practitioners during a feasibility study to address malnutrition risk. 是什么帮助或阻碍了初级保健干预的成功?在一项针对营养不良风险的可行性研究中,对老年人和初级保健从业人员的定性研究结果。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-23 DOI: 10.1186/s12875-024-02623-x
Liz Payne, Elisabeth Grey, Michelle Sutcliffe, Sue Green, Caroline Childs, Sian Robinson, Bernard Gudgin, Pam Holloway, Jo Kelly, Jackie Seely, Rebekah Le Feuvre, Paul Aveyard, Paramjit Gill, Mike Stroud, Paul Little, Yardley Lucy, Leanne Morrison

Background: In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those identified as 'at risk' may help reduce malnutrition risk and associated healthcare use, and improve quality of life. The aim of this study is to explore how primary care practitioners (PCPs) and older adults perceive, use and respond to an intervention to support those identified as 'at risk'.

Methods: We developed and optimised an intervention (screen and treat protocol, online tools and printed materials) to support primary care practitioners to identify malnutrition risk among older adults, and intervene where necessary. We recruited older adults (described as 'patients' here) taking part in a feasibility study, and carried out semi-structured interviews to assess PCPs' and patients' engagement with the intervention, and identify any contextual issues that supported or undermined their engagement.

Results: Four themes were developed, encompassing patients' and PCPs' perceptions of undernutrition, study measures and appointments, constraints on PCPs' enthusiasm to make a difference, and patients' expectations of nutritional appointments. Key findings included patients commonly not accepting advice for undernutrition/malnutrition but welcoming support for their nutritional needs; checklists potentially distracting patients from recalling discussions about their nutritional needs; a tension between PCPs' desire to recruit less-well patients and logistical difficulties in doing so; and patients compromising their nutritional needs to suit others.

Conclusions: Diverse factors influence whether an intervention succeeds in primary care. PCPs learn about an intervention/study in different ways, vary in how they understand and accept its aims, and desire to make a difference to their patients. Patients bring perceptions and expectations about the study's aims, coloured by their habits and preferences, prior experience of research and healthcare, and pressure from social expectations. Each aspect must be considered when developing a successful primary care intervention that is viewed as relevant and meaningful, and presented using language that aligns with participants' values and goals. Our findings suggest that references to 'malnutrition risk' should be avoided in any patient-facing materials/interactions as participants do not accept or identify with this label.

背景:在英国,65 岁及以上居住在社区的成年人中估计约有 14% 面临营养不良的风险。在初级保健中对老年人进行筛查,并对确定为 "有风险 "的老年人进行治疗,可能有助于降低营养不良的风险和相关医疗保健的使用,并提高生活质量。本研究旨在探讨初级保健医生(PCPs)和老年人如何看待、使用和响应一项干预措施,以支持那些被确定为 "高危 "人群:我们开发并优化了一项干预措施(筛查和治疗方案、在线工具和印刷材料),以支持初级保健医生识别老年人的营养不良风险,并在必要时进行干预。我们招募了参加可行性研究的老年人(此处称为 "患者"),并进行了半结构化访谈,以评估初级保健医生和患者对干预措施的参与度,并确定支持或削弱其参与度的任何背景问题:研究提出了四个主题,包括患者和初级保健医生对营养不良的看法、研究措施和预约、对初级保健医生改变现状的热情的限制,以及患者对营养预约的期望。主要发现包括:患者通常不接受有关营养不足/营养不良的建议,但欢迎为其营养需求提供支持;核对表可能会分散患者的注意力,使其无法回忆起有关其营养需求的讨论;初级保健医生希望招募健康状况较差的患者与招募过程中的后勤困难之间存在矛盾;以及患者为迎合他人而牺牲自己的营养需求:干预措施在初级保健中是否成功受多种因素影响。初级保健医生了解干预/研究的方式各不相同,他们对干预/研究目的的理解和接受程度也不尽相同,他们都希望能给病人带来改变。患者对研究目的的看法和期望,受其习惯和偏好、先前的研究和医疗保健经验以及社会期望压力的影响。在制定成功的初级保健干预措施时,必须考虑到每个方面,这些干预措施应被视为相关且有意义,并使用符合参与者价值观和目标的语言进行表述。我们的研究结果表明,在任何面向患者的材料/互动中,都应避免提及 "营养不良风险",因为参与者不会接受或认同这一标签。
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引用次数: 0
Barriers and facilitators to culturally sensitive care in general practice: a reflexive thematic analysis. 全科医疗中文化敏感性护理的障碍和促进因素:反思性专题分析。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-23 DOI: 10.1186/s12875-024-02630-y
Robin Vandecasteele, Lenzo Robijn, Sara Willems, Stéphanie De Maesschalck, Peter A J Stevens

Background: This study investigated the perceived barriers and potential facilitators for culturally sensitive care among general practitioners in Flanders. Understanding these dynamics is crucial for improving healthcare quality and equity.

Methodology: Twenty-one in-depth interviews were conducted with Flemish GPs. Braun and Clarke's reflexive thematic analysis was employed to develop and interpret themes that elucidate shared underlying meanings and capture the nuanced challenges and strategies related to cultural sensitivity in healthcare.

Results: Two core themes were generated: GPs' uncertainty and opposition. These themes manifest in emotional responses such as frustration, miscomprehension, and feelings of helplessness, influencing relational outcomes marked by patient disconnect and reduced motivation for cultural sensitivity. The barriers identified are exacerbated by resource scarcity and limited intercultural contact. Conversely, facilitators include structural elements like interpreters and individual strategies such as engagement, aimed at enhancing GPs' confidence in culturally diverse encounters. A meta-theme of perceived lack of control underscores the challenges, particularly regarding language barriers and resource constraints, highlighting the critical role of GPs' empowerment through enhanced intercultural communication skills.

Conclusion: Addressing GPs' uncertainties and oppositions can mitigate related issues, thereby promoting comprehensive culturally sensitive care. Essential strategies include continuous education and policy reforms to dismantle structural barriers. Moreover, incentivizing culturally sensitive care through quality care financial incentives could bolster GP motivation. These insights are pivotal for stakeholders-practitioners, policymakers, and educators-committed to advancing culturally sensitive healthcare practices and, ultimately, for fostering more equitable care provision.

研究背景本研究调查了佛兰德地区全科医生对文化敏感性护理的认知障碍和潜在促进因素。了解这些动态因素对于提高医疗质量和公平性至关重要:对佛兰德全科医生进行了 21 次深入访谈。采用布劳恩和克拉克的反思性主题分析法来制定和解释主题,以阐明共同的基本含义,并捕捉与医疗保健中的文化敏感性相关的细微挑战和策略:结果:产生了两个核心主题:全科医生的不确定性和反对。这些主题表现为挫败感、误解和无助感等情绪反应,影响了以患者脱节和文化敏感性动机降低为特征的关系结果。资源匮乏和有限的跨文化接触加剧了所发现的障碍。与此相反,促进因素包括翻译人员等结构性要素和参与等个人策略,旨在增强全科医生在不同文化接触中的信心。缺乏控制感这一元主题强调了所面临的挑战,尤其是在语言障碍和资源限制方面,突出了全科医生通过提高跨文化交流技能来增强自身能力的关键作用:结论:解决全科医生的不确定性和反对意见可以缓解相关问题,从而促进全面的文化敏感性护理。基本策略包括持续教育和政策改革,以消除结构性障碍。此外,通过优质护理经济激励措施来鼓励文化敏感性护理,可以提高全科医生的积极性。这些见解对于致力于推进文化敏感性医疗保健实践的利益相关者--从业者、政策制定者和教育者--至关重要,并最终促进提供更公平的医疗保健服务。
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引用次数: 0
The provision of bereavement care by general practitioners: data from a sentinel network. 全科医生提供的丧亲护理:来自哨点网络的数据。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-23 DOI: 10.1186/s12875-024-02625-9
Sophie C Renckens, H Roeline Pasman, Nienke J Veldhuijzen, Bregje D Onwuteaka-Philipsen

Background: Limited information exists regarding the prevalence of bereavement care provision by general practitioners (GPs) and in what cases they provide this. Insights into the current practice of bereavement care provision by GPs can highlight areas for improvement of the bereavement care practice. Therefore, we examined in how many cases GPs contacted relatives regarding bereavement care, and which case-specific characteristics are associated.

Methods: This study had a retrospective cross-sectional design and used data from a clustered sample of 52 GP-practices in the Netherlands. Patient cases were included if they were one year or older and died between January 1st, 2018 and December 31st, 2022. The main outcome was whether the GP had had contact with relatives regarding bereavement care or planned to do so. Descriptive statistics were used, as well as logistic regression analyses with generalized estimating equations.

Results: Following 86.4% of deaths, GPs either had contact with or planned to have contact with relatives of their deceased patients regarding bereavement care. This likelihood was higher in non-sudden deaths compared to sudden deaths (odds ratio [OR] 1.60). In cases of non-sudden death, GPs were more likely to provide bereavement care if an informal caregiver was involved (OR 3.81), or if the GP was part of a palliative care at home group (PaTz) (OR 2.78).

Conclusions: In the majority of cases GPs reach out to the relatives of their deceased patients to offer bereavement care. Given their familiarity with the deceased person, particularly instances of non-sudden death, the GP seems to be well-positioned to provide bereavement care, especially support that focuses on reviewing the period leading up to the death.

背景:关于全科医生(GPs)提供丧亲关怀的普遍程度以及在何种情况下提供这种关怀的信息有限。了解全科医生目前提供丧亲关怀的实践情况,可以突出丧亲关怀实践中需要改进的地方。因此,我们研究了全科医生就丧亲关怀与亲属联系的案例数量,以及与之相关的具体案例特征:本研究采用回顾性横断面设计,使用的数据来自荷兰 52 家全科医生诊所的聚类样本。在2018年1月1日至2022年12月31日期间死亡的年满1岁或1岁以上的患者病例均被纳入研究范围。主要结果是全科医生是否与亲属就丧亲护理进行过接触或计划这样做。结果显示,86.4%的死亡病例的全科医生曾与亲属就丧亲护理进行过联系,或计划进行联系:结果:86.4%的死亡病例发生后,全科医生曾就丧亲关怀事宜与死者亲属接触或计划与死者亲属接触。与猝死相比,非猝死患者的这种可能性更高(几率比 [OR] 1.60)。在非猝死病例中,如果有非正规护理人员参与(OR 3.81),或者全科医生是居家姑息关怀小组(PaTz)的成员(OR 2.78),全科医生就更有可能提供丧亲关怀:在大多数情况下,全科医生都会向逝者亲属提供丧亲关怀。鉴于全科医生对逝者的熟悉程度,尤其是在非猝死的情况下,全科医生似乎完全有能力提供丧亲关怀,尤其是侧重于回顾逝者生前的支持。
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引用次数: 0
Initial symptoms and late complication in Lyme neuroborreliosis from the perspective of patients and relatives: a qualitative study. 从患者和亲属的角度看莱姆神经源性疾病的初期症状和晚期并发症:一项定性研究。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-23 DOI: 10.1186/s12875-024-02624-w
Anita Nymark, Lotte Huniche, Sigurdur Skarphedinsson, Helle Marie Christensen

Background: Lyme borreliosis is by far the most common vector-borne infection in Western Europe. The most severe manifestation of Lyme borreliosis is Lyme neuroborreliosis (LNB). In LNB symptoms vary from mild to severe and may include late complications that involve both physical and/or neurocognitive constraints. An estimated 25-28% of the LNB population suffers from late complications. This study investigates patient and relative perspectives on everyday life with LNB symptoms, diagnosis, and treatment to identify areas for improvement of healthcare.

Methods: A focus group was conducted at Odense University Hospital, Denmark. The focus group comprised 16 participants, nine patients diagnosed with LNB who had been treated at the Clinical Center for Emerging and Vector-borne Infections, and seven relatives of the patients' choice. The focus group lasted 2 ½ hours and was audio recorded as well as documented in field notes.

Results: Data analysis was grounded in the conceptual framework of critical psychology and resulted in three main themes: (1) Burden of LNB symptoms in everyday life, (2) A break in the conduct of everyday life caused by LNB and (3) Need for transparent pathways to specialist knowledge.

Conclusions: Before diagnosis and treatment, each patient reported varying degrees of non-treatable pain, and cognitive and/or musculoskeletal symptoms. Visible physical symptoms were rare. All patients had experienced that their bodily symptoms remained unaddressed throughout numerous encounters with the healthcare system. The course of LNB comes with a break in patients' everyday lives and self-understandings affecting their ability to work and manage everyday activities. Patients and relatives strongly recommend a specialised LNB clinic.

背景:莱姆包虫病是西欧迄今为止最常见的病媒传染病。莱姆包虫病最严重的表现是莱姆神经包虫病(LNB)。莱姆神经瘫痪症的症状从轻微到严重不等,后期并发症可能涉及身体和/或神经认知方面的限制。据估计,25%-28%的 LNB 患者会出现晚期并发症。本研究调查了患者和亲属对 LNB 症状、诊断和治疗等日常生活的看法,以确定需要改进的医疗保健领域:方法:在丹麦欧登塞大学医院进行了一次焦点小组讨论。该小组由 16 名参与者组成,其中 9 名是在新发病例和病媒传染病临床中心接受过治疗的 LNB 患者,另外 7 名是患者选择的亲属。焦点小组讨论持续了两个半小时,并进行了录音和现场记录:数据分析以批判心理学的概念框架为基础,得出了三大主题:(1) LNB 症状给日常生活带来的负担;(2) LNB 导致日常生活中断;(3) 需要透明的途径获取专业知识:在诊断和治疗之前,每位患者都报告了不同程度的无法治疗的疼痛、认知症状和/或肌肉骨骼症状。明显的身体症状很少见。在与医疗系统的多次接触中,所有患者都经历过身体症状得不到解决的情况。LNB 病程会打破患者的日常生活和自我理解,影响他们的工作和日常活动能力。患者和亲属强烈建议去一家专门的 LNB 诊所就诊。
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引用次数: 0
Where do UK clinicians find information at the point of care? A pragmatic, exploratory study. 英国临床医生在护理点从何处获取信息?一项务实的探索性研究。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-23 DOI: 10.1186/s12875-024-02627-7
Margaret McCartney, Kate Connolly, Frank Sullivan, Carl Heneghan, Elijah Yu Heng Ho, Brid Hendry, Charlotte Salisbury, Sam Offer, David Nunan

Aim: To describe where clinical information is contemporarily and commonly found in UK primary care, what is favoured by clinicians, and whether this is (1) publicly funded (2) has commercial potential conflicts of interest.

Design and setting: A mixed methods study, consisting of (1) site visits to general practices in Scotland, (2) online questionnaire, focused on UK general practice (3) analysis of materials cited by professionals.

Methods: Data about sources of clinical information used was obtained verbally, visually and via search histories on computers from visits. This was used to inform a questionnaire in which primary care clinicians in the four nations of the UK were invited to participate. This obtained data about the information sources used and preferred by clinicians. This information was searched for data about funding and conflicts of interest.

Results: Over 2022, four practices were visited. 337 clinicians, 280 of whom were general practitioners completed an online questionnaire. 136 different resources were identified. These were mainly websites but sources of information included colleagues, either in practice or through online networks, apps, local guidelines, health charities, and learning resources aimed at GPs. Of these, 70 were not publicly funded, and were a mixture of membership organisations, charities, or sponsored venues.

Conclusions: Primary care clinicians obtain information for themselves and patients from a wide variety of sources. Funding is from a variety of sources and some contain advertising and/or sponsorship, risking commercial bias.

Protocol: Pre-published at https://osf.io/wrzqk .

目的:描述英国基层医疗机构中当代常见的临床信息,临床医生青睐的信息,以及这些信息是否(1)由政府资助(2)存在商业潜在利益冲突:一项混合方法研究,包括:(1) 实地考察苏格兰的全科实践;(2) 在线问卷调查,重点是英国的全科实践;(3) 分析专业人士引用的资料:方法:通过口头、直观以及访问过程中电脑的搜索历史记录获取有关临床信息来源的数据。我们利用这些数据制作了一份调查问卷,邀请英国四个国家的初级保健临床医生参加。调查获得了临床医生使用和偏好的信息来源数据。在这些信息中还搜索了有关资金和利益冲突的数据:在 2022 年期间,共访问了四家诊所。337 名临床医生(其中 280 人为全科医生)完成了在线问卷调查。确定了 136 种不同的资源。这些资源主要是网站,但信息来源也包括实践中的同事或通过在线网络、应用程序、地方指南、健康慈善机构以及针对全科医生的学习资源。其中,有 70 个不是由政府资助的,是会员组织、慈善机构或赞助场所的混合体:结论:初级保健临床医生从各种渠道为自己和患者获取信息。资金来源多种多样,有些还包含广告和/或赞助,存在商业偏见的风险:预发表于 https://osf.io/wrzqk 。
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引用次数: 0
Caring for Long Covid patients in primary healthcare: a cross-sectional study on general practitioners' knowledge, perception and experience in Belgium and Malta. 在初级医疗保健中照顾长期住院病人:关于比利时和马耳他全科医生的知识、看法和经验的横断面研究。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-21 DOI: 10.1186/s12875-024-02617-9
Sarah Moreels, Sherihane Bensemmane, Robrecht De Schreye, Sarah Cuschieri

Background: At least 10% of Covid-19 recovered individuals experience persistent symptoms (Long Covid). Primary healthcare and general practitioners (GPs) are at the forefront in their care. In this study, GPs' knowledge, perceptions and experiences with Long Covid, and the definition used in two countries, are investigated to provide insight into GPs' care for Long Covid patients at a cross-country level.

Methods: A cross-sectional study targeted towards GPs was conducted in Belgium and Malta during spring and early summer 2022. An online survey consisting of 15 questions on Long Covid was disseminated. Additionally, country-specific practice and demographic characteristics were collected. Descriptive and logistic regression analyses were performed.

Results: A total of 150 GPs (Belgium = 105; Malta = 45) responded. Female GPs represented 58.0%, median age was 49 years (IQR: 37-61). Concerning GPs' knowledge and perception on Long Covid, in both countries, most GPs reported insufficient scientific knowledge and information on Long Covid diagnosis and treatment. Access to educational material was limited and an awareness-rising campaign on Long Covid was deemed necessary. Moreover, two out of three GPs stated that Long Covid patients were not well followed up by primary healthcare in mid-2022. For diagnosing Long Covid, 54.7% required a positive Covid-19 test, more often among Belgian GPs than Maltese (64.3% vs. 45.2%, p = 0.036). To assess Long Covid, GPs mainly applied diagnostic criteria by themselves (47.3%) in combination with persistent symptoms (4 weeks to 5 months). Most GPs had experience with Long Covid patients in their practice, regardless of practice type and GPs' country, sex or age (p = 0.353; p = 0.241; p = 0.194; p = 0.058). Although most GPs (94.7%) stated that Long Covid patients should follow multidisciplinary approach, 48.3% reported providing care for these patients themselves or with GP colleagues and only 29.8% by multidisciplinary cooperation.

Conclusions: GPs frequently provide (multidisciplinary) care to Long Covid patients and GPs' care showed similarities at cross-country level. Although GPs perceive lack of scientific knowledge and educational material on Long Covid, similar diagnostic criteria among GPs were noted. Uniform evidence-based guidelines, scientific support and training for GP across Europe must be a priority to enhance their treatment approach to Long Covid.

背景:至少 10%的 Covid-19 康复者会出现持续症状(Long Covid)。初级医疗保健和全科医生(GPs)在他们的护理中处于最前沿。本研究调查了全科医生对长Covid的了解、看法和经验,以及两个国家所使用的定义,以便深入了解全科医生对长Covid患者的跨国护理情况:方法:2022 年春季和初夏,在比利时和马耳他开展了一项针对全科医生的横断面研究。网上调查包括 15 个有关 Long Covid 的问题。此外,还收集了特定国家的实践和人口特征。结果显示,共有 150 名全科医生(比利时)接受了调查:共有 150 名全科医生(比利时=105;马耳他=45)做出了回应。女性全科医生占 58.0%,年龄中位数为 49 岁(IQR:37-61)。关于全科医生对朗阁维德的了解和看法,两国大多数全科医生都表示对朗阁维德的诊断和治疗缺乏足够的科学知识和信息。获得教育材料的途径有限,因此有必要开展朗科维德宣传活动。此外,每三名全科医生中就有两名表示,2022 年中期,基层医疗机构没有对 Long Covid 患者进行良好的随访。在诊断 Long Covid 时,54.7% 的患者需要 Covid-19 检测呈阳性,比利时全科医生的这一比例高于马耳他全科医生(64.3% 对 45.2%,P = 0.036)。在评估长Covid时,全科医生主要是结合持续症状(4周至5个月)自行应用诊断标准(47.3%)。大多数全科医生在其执业过程中都曾接诊过 Long Covid 患者,与执业类型、全科医生所在国家、性别或年龄无关(P = 0.353;P = 0.241;P = 0.194;P = 0.058)。尽管大多数全科医生(94.7%)表示,Long Covid 患者应遵循多学科方法,但 48.3% 的全科医生表示,他们自己或与全科医生同事一起为这些患者提供护理,只有 29.8% 的全科医生通过多学科合作为患者提供护理:结论:全科医生经常为长 Covid 患者提供(多学科)护理,全科医生的护理在跨国层面上显示出相似性。尽管全科医生认为缺乏有关长Covid的科学知识和教育材料,但全科医生的诊断标准相似。必须在欧洲范围内优先为全科医生提供统一的循证指南、科学支持和培训,以加强他们对长涎管病的治疗方法。
{"title":"Caring for Long Covid patients in primary healthcare: a cross-sectional study on general practitioners' knowledge, perception and experience in Belgium and Malta.","authors":"Sarah Moreels, Sherihane Bensemmane, Robrecht De Schreye, Sarah Cuschieri","doi":"10.1186/s12875-024-02617-9","DOIUrl":"10.1186/s12875-024-02617-9","url":null,"abstract":"<p><strong>Background: </strong>At least 10% of Covid-19 recovered individuals experience persistent symptoms (Long Covid). Primary healthcare and general practitioners (GPs) are at the forefront in their care. In this study, GPs' knowledge, perceptions and experiences with Long Covid, and the definition used in two countries, are investigated to provide insight into GPs' care for Long Covid patients at a cross-country level.</p><p><strong>Methods: </strong>A cross-sectional study targeted towards GPs was conducted in Belgium and Malta during spring and early summer 2022. An online survey consisting of 15 questions on Long Covid was disseminated. Additionally, country-specific practice and demographic characteristics were collected. Descriptive and logistic regression analyses were performed.</p><p><strong>Results: </strong>A total of 150 GPs (Belgium = 105; Malta = 45) responded. Female GPs represented 58.0%, median age was 49 years (IQR: 37-61). Concerning GPs' knowledge and perception on Long Covid, in both countries, most GPs reported insufficient scientific knowledge and information on Long Covid diagnosis and treatment. Access to educational material was limited and an awareness-rising campaign on Long Covid was deemed necessary. Moreover, two out of three GPs stated that Long Covid patients were not well followed up by primary healthcare in mid-2022. For diagnosing Long Covid, 54.7% required a positive Covid-19 test, more often among Belgian GPs than Maltese (64.3% vs. 45.2%, p = 0.036). To assess Long Covid, GPs mainly applied diagnostic criteria by themselves (47.3%) in combination with persistent symptoms (4 weeks to 5 months). Most GPs had experience with Long Covid patients in their practice, regardless of practice type and GPs' country, sex or age (p = 0.353; p = 0.241; p = 0.194; p = 0.058). Although most GPs (94.7%) stated that Long Covid patients should follow multidisciplinary approach, 48.3% reported providing care for these patients themselves or with GP colleagues and only 29.8% by multidisciplinary cooperation.</p><p><strong>Conclusions: </strong>GPs frequently provide (multidisciplinary) care to Long Covid patients and GPs' care showed similarities at cross-country level. Although GPs perceive lack of scientific knowledge and educational material on Long Covid, similar diagnostic criteria among GPs were noted. Uniform evidence-based guidelines, scientific support and training for GP across Europe must be a priority to enhance their treatment approach to Long Covid.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Perceptions of the 2D short animated videos for literacy against chronic diseases among adults with diabetes and/or hypertension: a qualitative study in primary care clinics. 糖尿病和/或高血压成人对二维动画短片进行慢性病扫盲的看法:一项在初级保健诊所进行的定性研究。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-21 DOI: 10.1186/s12875-024-02621-z
Panan Pichayapinyo, Malinee Sompopcharoen, Weena Thiangtham, Jutatip Sillabutra, Phenchan Meekaew, Benyada Bureerat, Armote Somboonkaew

Background: Animation has promise for teaching complex health content through smartphone applications. However, smartphones have had limited use in Thailand for health literacy improvement among adults with chronic diseases. This study aims to explore the perceptions of adults with diabetes and/or hypertension resulting from 2D short animated videos for literacy against chronic disease that are available via smartphones.

Methods: Four animated videos were initially developed based on clinical practice guidelines and nursing experience. Physicians, an expert in health education, and an animation team developed and revised scripts and storyboards of the animated videos. Lastly, videos were validated by physicians and health educators for content breadth and depth and by media experts for motion graphics and illustration. Each video presents a different situation in diabetes, hypertension, missing appointments, and obesity, ranging from 2.18 to 4.14 min in duration. The inclusion criteria were adults 35-70 years old with diabetes or hypertension who received care from primary care units. Thematic analysis was performed on the extracted data.

Results: Twenty participants with a mean age of 58.4 years (SD 6.7; ranged 41-68) were focus-group interviewed. Three animation elements were assessed, including presentation, impacts, and suggestions. Participants had positive responses regarding the presentation (suitability of images and smooth motion graphics, short length of videos, simple language, understandable content, and clear sound) and impacts (recalling information, enhancing engagement, and motivating health awareness and behavior change). Suggested improvements were for a bigger font size for subtitles and considering the use of spoken text instead of on-screen text for recommendations at the end of the animations.

Conclusions: Animated videos are acceptable for delivering health information. Pilot testing animated videos for promoting literacy against chronic diseases in adults with diabetes and hypertension is needed for optimal utility.

背景:动画有望通过智能手机应用程序教授复杂的健康内容。然而,在泰国,智能手机在提高慢性病成人健康素养方面的应用还很有限。本研究旨在探讨糖尿病和/或高血压成人患者对通过智能手机获得的二维动画短片进行慢性病知识扫盲的看法:方法:最初根据临床实践指南和护理经验开发了四部动画视频。医生、一名健康教育专家和一个动画制作团队共同开发并修改了动画视频的脚本和故事板。最后,医生和健康教育专家对视频内容的广度和深度进行了验证,媒体专家对动态图形和插图进行了验证。每个视频介绍了糖尿病、高血压、失约和肥胖的不同情况,时长从 2.18 分钟到 4.14 分钟不等。纳入标准为 35-70 岁、患有糖尿病或高血压、在初级医疗单位接受治疗的成年人。对提取的数据进行了主题分析:对 20 名参与者进行了焦点小组访谈,他们的平均年龄为 58.4 岁(标准差 6.7;41-68 岁不等)。对三个动画元素进行了评估,包括演示、影响和建议。参与者对动画的表现形式(图像和流畅的动态图形的适宜性、视频长度短、语言简单、内容易懂、声音清晰)和影响(回忆信息、提高参与度、激发健康意识和行为改变)给予了积极评价。建议的改进措施包括加大字幕的字体大小,以及考虑在动画片结尾处使用口述文字而不是屏幕文字来提出建议:结论:动画视频在传递健康信息方面是可以接受的。需要对促进糖尿病和高血压成人慢性病知识普及的动画视频进行试点测试,以获得最佳效用。
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引用次数: 0
The TELEhealth Shared decision-making COaching and navigation in Primary carE (TELESCOPE) intervention: a study protocol for delivering shared decision-making for lung cancer screening by patient navigators. TELEhealth初级医疗中的共同决策辅导和导航(TELESCOPE)干预:由患者导航员提供肺癌筛查共同决策的研究方案。
IF 2 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-18 DOI: 10.1186/s12875-024-02610-2
Naomi Q P Tan, Lisa M Lowenstein, Elisa E Douglas, Jeanne Silva, Joshua M Bershad, Jinghua An, Sanjay S Shete, Michael B Steinberg, Jeanne M Ferrante, Elizabeth C Clark, Ana Natale-Pereira, Novneet N Sahu, Shirin E Hastings, Richard M Hoffman, Robert J Volk, Anita Y Kinney

Background: Lung cancer screening (LCS) can reduce lung cancer mortality but has potential harms for patients. A shared decision-making (SDM) conversation about LCS is required by the Centers for Medicare & Medicaid Services (CMS) for LCS reimbursement. To overcome barriers to SDM in primary care, this protocol describes a telehealth decision coaching and navigation intervention for LCS in primary care clinics delivered by patient navigators. The objective of the study is to evaluate the effectiveness of the intervention and its implementation potential, compared with an enhanced usual care (EUC) arm.

Methods: Patients (n = 420) of primary care clinicians (n = 120) are being recruited to a cluster randomized controlled trial. Clinicians are randomly assigned to 1) TELESCOPE intervention: prior to an upcoming non-acute clinic visit, patients participate in a telehealth decision coaching and navigation session about LCS delivered by trained patient navigators and nurse navigators place a low-dose CT scan (LDCT) order for each TELESCOPE patient wanting LCS, or 2) EUC: patients receive enhanced usual care from a clinician. Usual care is enhanced by providing clinicians in both arms with access to a Continuing Medical Education (CME) webinar about LCS and an LCS discussion guide. Patients complete surveys at baseline and 1-week after the scheduled clinic visit to assess quality of the SDM process. Re-navigation is attempted with TELESCOPE patients who have not completed the LDCT within 3 months. One month before being due for an annual screening, TELESCOPE patients whose initial LCS showed low-risk findings are randomly assigned to receive a telehealth decision coaching booster session with a navigator or no booster. Electronic health records are abstracted at 6, 12 and 18 months after the initial decision coaching session (TELESCOPE) or clinic visit (EUC) to assess initial and annual LCS uptake, imaging results, follow-up testing for abnormal findings, cancer diagnoses, treatment, and tobacco treatment referrals. This study will evaluate factors that facilitate or interfere with program implementation using mixed methods.

Discussion: We will assess whether a decision coaching and patient navigation intervention can feasibly and effectively support high-quality SDM for LCS and guideline-concordant LCS uptake for patients in busy primary care practices serving diverse patient populations.

Trial registration: This study was registered at ClinicalTrials.gov (NCT05491213) on August 4, 2022.

Protocol version: Version 1, April 10, 2024.

背景:肺癌筛查(LCS)可降低肺癌死亡率,但对患者有潜在危害。美国医疗保险与医疗补助服务中心(CMS)要求就肺癌筛查进行共同决策(SDM)对话,以获得肺癌筛查报销。为了克服初级保健中 SDM 的障碍,本方案介绍了由患者导航员在初级保健诊所提供的远程保健决策指导和 LCS 导航干预。研究的目的是评估该干预措施的有效性及其实施潜力,并与增强型常规护理(EUC)臂进行比较:方法:一项分组随机对照试验正在招募初级保健临床医生(120 人)的患者(420 人)。临床医生被随机分配到 1) TELESCOPE 干预:在即将进行的非急性门诊就诊之前,患者参加由训练有素的患者导航员提供的关于 LCS 的远程医疗决策辅导和导航会议,护士导航员为每位想要接受 LCS 的 TELESCOPE 患者下达低剂量 CT 扫描 (LDCT) 订单;或 2) EUC:患者接受临床医生提供的增强型常规护理。通过向两组临床医生提供有关 LCS 的继续医学教育 (CME) 网络研讨会和 LCS 讨论指南,加强常规护理。患者在基线和预定门诊后一周完成调查,以评估 SDM 过程的质量。对于在 3 个月内未完成 LDCT 的 TELESCOPE 患者,将尝试重新导航。在年度筛查到期前一个月,初次 LCS 显示为低风险结果的 TELESCOPE 患者会被随机分配到接受导航员远程健康决策指导强化课程或不接受强化课程。在初次决策指导会话(TELESCOPE)或门诊就诊(EUC)后的 6、12 和 18 个月抽取电子健康记录,以评估初次和年度 LCS 的接受情况、成像结果、异常结果的后续检测、癌症诊断、治疗和烟草治疗转诊。本研究将采用混合方法评估促进或干扰计划实施的因素:我们将评估决策指导和患者导航干预措施能否可行、有效地支持高质量的低碳碳治疗SDM,以及在繁忙的初级医疗实践中为不同患者群体提供符合指南的低碳碳治疗:本研究于2022年8月4日在ClinicalTrials.gov(NCT05491213)注册:第 1 版,2024 年 4 月 10 日。
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