BMC primary care最新文献

Background: Primary health care for young and middle-aged individuals is often overlooked, with insufficient placed on workplace services provided by family doctors. This study aims to establish expert consensus on a comprehensive set of scientific and systematic indicators for workplace services provided by family doctors.

Methods: Based on prior literature and the established Structure-Process-Outcome (SPO) model, we designed two rounds of expert consultation using the Delphi method. A panel of 35 experts from diverse fields-including academia, medical institutions, and relevant health authorities-was composed, collectively possessing substantial expertise in healthcare delivery. The experts indicated their levels of agreement regarding the importance of different indicators for assessing workplace services provided by family doctors. Consensus was defined as achieving a threshold of 70% agreement.

Results: After two Delphi rounds, 42 out of 46 indicators reached high consensus, with authority coefficients > 0.7 and coefficients of variation < 0.25. Consensus on high importance (scores 7-9) ranged between 71.43% and 97.14% across four dimensions: organizational structure and management (5 indicators, 88.57%-94.29% consensus); content and form of services (17 indicators, 77.14%-94.29% consensus); synergy, incentive, and feedback mechanisms (10 indicators, 85.71%-97.14% consensus); and effectiveness of services (10 indicators, 71.43%-85.71% consensus).

Conclusions: This study establishes four dimensions and 42 potential indicators that serve as a foundational framework for assessing and improving workplace services offered by family doctors, and provide essential guidance for health management among individuals in the workplace. The high consensus achieved among experts concerning specific indicators associated with such workplace services prompts their practical implementation to provide an objective basis for evidence-based health management within workplace populations.

Background: Renin-angiotensin system inhibitors (RASis), including ACE inhibitors (ACEis) and angiotensin receptor blockers (ARBs), are commonly initiated in primary care for various clinical indications. However, the risk of hyperkalaemia and increased serum creatinine levels after initiation has not been well studied in Asian populations.

Methods: We conducted a retrospective cohort study of all patients aged 18 years and older who initiated RASi treatment at National University Polyclinics, a network of seven primary care clinics in Singapore, between 28 September 2020 and 31 June 2024. The study outcomes were the incidence of hyperkalaemia and elevated serum creatinine levels after RASi initiation. Multivariable regression was used to evaluate the covariates associated with these outcomes.

Results: The cohort comprised 9,926 patients whose baseline creatinine and post-initiation creatinine or potassium data were available. Within our cohort, 181 patients (1.8%) had hyperkalaemia, comprising 149 (1.5%) mild cases, 28 (0.3%) moderate cases and 4 (< 0.1%) severe cases; 249 (2.5%) patients had a major elevation in serum creatinine of 30% or more from baseline. Risk factors for hyperkalaemia include age, Indian or 'Other' ethnicity, increased baseline serum creatinine and increased baseline serum potassium. For major serum creatinine elevation, risk factors included 'Other' ethnicity, comorbid diabetes mellitus and concomitant diuretic use.

Conclusion: Hyperkalaemia and major serum creatinine elevation are uncommon adverse events following RASi initiation.

Background: Project Colourful, an innovative model for delivering team-based care and improving access to family physicians at a specific Canadian clinic, provided a window on how physician-led primary care teams are evolving. Colourful allowed an action research team to draw out broadly applicable policy lessons as family physicians moved from exclusively 'quarterbacking' direct patient care to also taking on a more off-field role as 'coaches' of registered nurses.

Methods: Participant observations (n = 12) of Colourful's design and implementation were supplemented with semi-structed interviews (n = 11) that focused on the project's origins; plans for scaling; and interprofessional teamwork issues. Transcribed interviews were analysed using an interpretive descriptive approach.

Results: The shift from quarterback to coach requires not only payment reform, but cultural change and training for physicians and other team members. Specific training here focuses on developing human resource skills and capacities that span: hiring, scope-of practice education, team dynamics, team member retention, and change management.

Conclusions: Key support, resource, and governance considerations for policy makers looking to scale care models like Colourful include education to: flatten traditional interprofessional hierarchies; enable the communication required for successful teamwork; as well as, bolster the HR skills of physician coaches; ensure an optimized interprofessional mix; and empower team members to renegotiate scopes of practice at clinical and provincial levels.

Background: Musculoskeletal disorders (MSDs) are frequent and disabling conditions in primary care and contribute substantially to general practitioners' (GPs) workload. Direct access (DA) to physiotherapy, allowing patients to consult physiotherapists without prior medical referral, has been proposed to streamline care, reduce delays, and optimise resource use. This systematic review synthesized the effects of DA on GPs' practice and the organisation of primary care for adults with MSDs.

Methods: Following PRISMA 2020, we systematically searched 12 databases/platforms (MEDLINE/PubMed, Embase, Cochrane Library, CINAHL, PEDro, Web of Science, Scopus, Cairn.info, Érudit, ClinicalTrials.gov) and discovery platforms (ScienceDirect, Google Scholar), plus grey literature, from 15 July 2024 to 4 November 2025 (initial search 15 July-15 October 2024; updated search 1 January 2024-4 November 2025). Eligible studies assessed the consequences of DA to physiotherapy for MSDs in primary care versus GP-referred pathways (referral-based usual care). Two reviewers independently screened, extracted data, as well as appraised quality using the Newcastle-Ottawa Scale (observational studies), ROB 2.0 (RCTs), and graded certainty using GRADE at the study level. Outcomes included GP workload, imaging and medication prescriptions, clinical results, costs, and safety.

Results: We included 21 studies (7 RCTs, 14 observational) totaling 90 401 patients (15 017 DA; 75 384 GP-referred). Across 15 studies, DA was associated with 10-30% fewer GP consultations. 14 studies reported reduced imaging and medication use under DA; effects on prescriptions were context-dependent. 14 studies showed non-inferior clinical outcomes, with small early advantages in some RCTs. 13 studies assessed costs, indicating neutral to reduced per-episode costs; two RCT-linked economic analyses were comparable or favorable to DA. No serious adverse events attributable to DA were reported (5 studies). GRADE certainty was moderate in 2, low in 12, and very low in 5 studies, limited by observational predominance and small RCT samples. Totals refer to study-level GRADE assessments (n = 19), as two economic evaluations were linked to their parent RCTs.

Conclusions: In adults with MSDs, DA to physiotherapy appears to lessen GP workload and resource use with clinical outcomes similar to GP-referred pathways and no consistent signal of increased harms. Given methodological limitations, further robust comparative studies are warranted to inform large-scale implementation and policy in primary care.

Trial registration: OSF (ID 897ub; registered 15 August 2024; https://osf.io/897ub/).

Background: Atrial fibrillation (AF) is a common, often silent, arrhythmia that markedly increases stroke risk yet remains undiagnosed in many high-risk adults. Mobile electrocardiogram technology in community pharmacies has detected 1-5% new AF internationally, but real-world pharmacist-led data in Southern Europe are scarce. Our study screened adults ≥ 55 years with cardiovascular risk factors in Spanish pharmacies to determine the frequency of undiagnosed AF and facilitate early stroke prevention.

Methods: A quasi-experimental multicenter cross-sectional study was conducted in Community Pharmacies, Health Centers and Auxiliary Clinics in the Basic Health Area of Sagunto and Puerto de Sagunto (Spain) between April and June 2024. Community pharmacy users aged 55 years or older, with at least one risk factor, were included: hypertension, diabetes, heart failure, coronary heart disease, chronic kidney disease, BMI > 30 kg/m2, obstructive sleep apnea and who had signed the informed consent form.

Primary variable: 1-lead electrocardiogram (ECG) result.

Results: 784 users were included, with a mean age of 70.1 years (SD = 8.0). From the 62 (7.9%) users identified with an alteration in the 1-lead ECG, 36 (58.1%) corresponded to a possible AF. Of these, thirty-four were referred to the Health Centre for confirmation by 12-lead ECG. Six patients (17.6%) were diagnosed with AF.

Conclusions: Opportunistic AF screening in Community Pharmacies, using portable technology, is a viable strategy to identify potential cases of undiagnosed AF in the at-risk population, contributing to early diagnosis of the arrhythmia and thus to stroke prevention.

Trial registration: Not applicable.