BMC primary care最新文献

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.

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.