Primary health care research & development最新文献

Background: Veterans Affairs Medical Centers offer multiple weight-loss treatments, including a comprehensive lifestyle intervention program (i.e., MOVE!), anti-obesity medications (AOMs) and bariatric surgery. Yet, most eligible veterans do not receive these treatments.

Aim: To describe the design, rationale, and planned evaluation of a comprehensive Weight Management and Metabolic Health program (WMMHP), consisting of (1) weight-focused visits with physicians or pharmacists trained in obesity medicine; (2) patient-centered use of available weight-loss treatments; and (3) coordinated, team-based care.

Methods: This is a quality improvement program implemented within the VA Ann Arbor Healthcare System. WMMHP eligibility criteria include body mass index (BMI) ≥ 30 kg/m² or BMI ≥ 27 kg/m² and ≥ 1 weight-related condition and participation in the MOVE! program. We plan to conduct an 18-month retrospective program evaluation using a propensity-matched cohort analysis to estimate the added benefit of WMMHP vs. MOVE! alone. The primary outcome will be mean change in weight at 18 months after baseline. Secondary outcomes will include mean weight loss at 6, 12, and 24 months, percentage of patients achieving thresholds of ≥ 5%, ≥ 10%, and ≥ 15% weight loss, initial prescriptions for and refilled prescriptions as a measure of adherence to AOMs, and referrals to, engagement with, and completion of bariatric surgery. We will also examine between-group differences in health system resource utilization.

Discussion: The WMMHP is an innovative approach to improving treatment and outcomes for veterans with overweight and obesity. If effective, its components may inform obesity care delivery in VA and non-VA settings.

Objective: Poverty is a risk factor for poor health. We sought to determine the practices, barriers, knowledge and comfort with poverty screening and intervention amongst family physicians (FPs), family medicine residents (FMRs) and family nurse practitioners (NPs) in Saskatchewan, Canada during the COVID-19 pandemic.

Methods: A survey was distributed by email and newsletters to FPs, FMRs and NPs in Saskatchewan during 2022.

Results: Eighty-three FPs, 35 FMRs and 25 NPs responded. Time, patient factors, practitioner knowledge and availability of community resources/services were reported barriers. Comfort discussing government benefits with patients was low, with slight differences amongst provider groups (p =.042). Thirty-one (40.3%) FPs, 7 (20.6%) FMRs and 17 (68.0%) NPs had referred a patient to a government benefit. Eight (6%) respondents used the Poverty Screening Tool.

Discussion: Further research and training is needed to integrate poverty screening and intervention into primary care, given practitioners' role as healthcare's initial point of contact.

Background: Identifying diagnoses from noncoded healthcare visit records presents logistical challenges when large number of records are screened. This study aimed to develop a screening process to identify otitis media (OM) diagnoses in free-text primary care visit records.

Methods: The free-text primary care records of 200 children aged 0 to 4 years were reviewed independently by three clinicians to determine whether OM was a diagnosis considered during each visit. Terms (abbreviations, words, and phrases) identifying visits where OM was considered or excluded were documented. These terms were used to design a software algorithm subsequently used to detect OM diagnosis within these primary care records. The diagnostic performance of the software algorithm was determined against the gold standard clinicians' review and described using sensitivity, specificity, predictive values (PVs), and likelihood ratios (LRs) with 95% confidence intervals (CIs).

Results: The 200 children had 10,034 primary care visits. Clinician review identified 917 (9%) visits where OM was considered, and 9117 (91%) visits where OM was excluded. The software algorithm identified 801/917 visits where OM was considered and 8705/9117 visits where OM was excluded. The algorithm sensitivity was 87% (95% CI 85-89), specificity 96% (95% CI 95-96), positive PV 66% (95% CI 63-69), negative PV 99% (95% CI 98-99), positive LR 19.33 (95% CI 17.54-21.31), and negative LR 0.13 (95% CI 0.11-0.16).

Conclusion: Software algorithms can assist in screening healthcare visit records. When combined with clinician review, they enable accurate identification of OM visits from non-coded records.

Aim: This study aimed to develop a transparent district-level Maternal and Child Health (MCH) index for Uttar Pradesh (UP), India, using a hybrid methodological framework integrating Analytic Hierarchy Process (AHP), Technique for Order Preference by Similarity to Ideal Solution (TOPSIS), and Geographic Information Systems (GIS), to support spatially targeted and equitable health planning.

Background: MCH is a key indicator of equity and effectiveness within health systems, directly impacting the wellbeing of mothers and children. Despite global efforts, many low-and middle-income countries continue to face preventable maternal deaths and child illnesses. In Uttar Pradesh (UP), substantial inter-district disparities in MCH outcomes persist but are often masked by state-level averages, hindering targeted policy and resource allocation.

Methods: We applied a hybrid Multi-Criteria Decision-Making (MCDM) framework. AHP was used to assign weights to nine key MCH indicators covering antenatal care, skilled birth attendance, child immunization, and nutrition based on National Family Health Survey (NFHS-5, 2019-21) data across 75 districts. TOPSIS was then employed to rank districts by overall MCH performance. GIS was used to visualize spatial disparities and identify clusters of high and low performance.

Findings: The MCH Index revealed substantial spatial disparities across UP. Districts such as Barabanki, Mahamaya Nagar, and Unnao ranked highest, while eastern UP and Bundelkhand showed lower performance. AHP assigned the highest importance to skilled birth attendance (22%) and antenatal care visits (22%). TOPSIS rankings highlighted gaps in maternal health services in socioeconomically marginalized districts. GIS mapping identified clusters of vulnerability linked to infrastructure and poverty. The AHP-TOPSIS-GIS framework provides a replicable method for sub-state MCH assessment, enabling policymakers to prioritize underserved districts and reduce geographic health outcomes. The findings underscore the need for decentralized, equity-focused strategies tailored to local contexts. Future research should incorporate temporal changes and socio-environmental factors to strengthen planning and monitoring.

Aim: The study aims to understand the perceptions of deprescribing in primary care for patients with a limited life expectancy.

Background: In the setting of limited life expectancy, medications may become inappropriate when the possible harms of use outweigh the benefits. Whilst the cessation of potentially inappropriate medications is associated with improved patient outcomes, incorporating this process into routine primary care is poorly enacted.

Methods: Qualitative interview study performed in primary care settings in the Netherlands, including primary care health professionals, patients with limited life expectancy, and their caregivers. Semi-structured interviews were conducted and analysed using inductive thematic analysis.

Findings: Three key themes emerged: (1) facilitating well-being, (2) preventing harm, and (3) dealing with uncertainty. A key goal of mediation use is to facilitate well-being, although the perceptions of this effect may not always match the reality due to changed clinical circumstances. The decision to continue or stop medication is influenced by the wish to prevent harm and to what extent participants find ways to deal with the uncertainties facing them.Reluctance to deprescribe medications is often related to uncertainties around ceasing medications, lack of clear clinical guidance, and the evolving situation of advanced illness. Integrating these discussions into routine primary care for patients with chronic and incurable illnesses may assist patients and healthcare professionals to address issues around medication use in a proactive manner and promote advance care planning discussions.

Aim: To explore nurses' perceptions regarding their knowledge, degree of autonomy, and the difficulties encountered in managing diabetic foot in Primary Care.

Background: Diabetes mellitus is a chronic condition with a high prevalence in Spain, predominantly type 2. One of its most serious complications is diabetic foot disease, affecting between 19% and 34% of patients and associated with considerable morbidity and amputation risk. Primary Care, particularly nursing professionals, plays a pivotal role in the prevention, assessment, and management of diabetic foot. However, institutional, methodological, and personal barriers continue to affect care quality.

Methods: A descriptive, cross-sectional observational study was conducted using quantitative and qualitative methods. A validated ad hoc questionnaire was administered to 176 nurses from the Murcian Health Service participating in a blended learning course on diabetic foot. Variables assessed included professional autonomy, knowledge, dressings use, clinical documentation, training, and perceived challenges. Qualitative analysis was based on open-ended responses using content analysis.

Findings: A total of 88.1% of nurses reported autonomy in performing foot examinations; however, only 45.5% managed wound care independently. Just 19.9% considered themselves sufficiently trained, while 42.6% felt confident in selecting dressings appropriate to the healing phase. Although 56.8% regularly completed specific clinical documentation forms, many still expressed uncertainty about dressing use. Qualitative analysis identified five key barriers: lack of knowledge, patient complexity, institutional constraints, issues of authority and communication, and professional insecurity. These findings provide a current picture of persistent barriers in diabetic foot care and reinforce the need for targeted training and institutional support.

Aim: The aim of this study is to investigate family physicians' approaches to hoarseness (dysphonia), clinical decision-making, patients' perceptions, and structural barriers in the healthcare system using qualitative methods.

Methods: Qualitative design was used. Research was reported in line with COREQ (32 items) and EQUATOR (SRQR) guidelines. Semi-structured telephone/internet interviews were conducted with 17 family physicians working primary care in Türkiye. Participants purposively sampled interviews were audio-recorded, transcribed, coded using thematic analysis, and developed themes.

Results: The analysis revealed four main themes: clinical assessment and differential diagnosis, referral criteria and specialist referrals, patient perception and knowledge level, health system and structural barriers. Demographic analysis determined that veteran doctors were more sensitive to malignancy, junior doctors highlighted systemic deficits, female doctors highlighted patient behavior, while doctors who practiced in rural areas highlighted structural issues.

Conclusion: Family physicians' handling of hoarseness is not only dependent on clinical data but also on patient opinion and the health system's conditions. For productive primary care management of hoarseness, it is recommended to (i) design guidelines and training for family physicians, (ii) increase patient education on voice hygiene and voice health, and (iii) establish health policies enhancing specialist accessibility.

Aim: The aim of this study was to explore the acceptability of an educational video among primary care clinicians as a tool to promote the use of stigma-free language in interactions with individuals with type 2 diabetes (T2D).

Background: The language used by primary care clinicians in interactions with adults living with T2D can contribute to perceptions and experiences of diabetes-related stigma and be a barrier to achieving and sustaining glycaemic targets. In 2017, the American Diabetes Association (ADA) and the Association for Diabetes Care & Education Specialists (ADCES) issued a guidance paper with recommendations to promote stigma-free communication about diabetes.

Methods: The educational video, developed by the research team, presents two versions of a vignette in which a nurse practitioner interacts with an adult with T2D in a primary care setting. The first version of the vignette features the nurse practitioner using stigmatizing language as outlined in the ADA and ADCES guidance paper; the second demonstrates the use of stigma-free language by the nurse practitioner. A narrator highlights the linguistic differences. The study participants, comprising physicians (n = 8), nurse practitioners (n = 9), and physician assistants (n = 1), were recruited through professional networks and via online forums and listservs for healthcare professionals. Participants viewed the educational video and were interviewed via Zoom by a research team member using a semi-structured interview guide. The transcripts of the interviews were analysed using a qualitative descriptive approach.

Findings: Three main themes emerged from the data: aligning video content with existing attitudes and beliefs, reducing the use of stigmatizing language, and increasing the use of stigma-free language. Findings suggest that an educational video promoting the use of stigma-free language in interactions with adults with T2D is acceptable among primary care clinicians.

Background: The health of migrants with type 2 diabetes has become a public health concern. Minority populations, including migrants, are often considered 'hard-to-reach groups' in clinical research, as researchers face challenges in engaging, accessing and retaining participants. Previous reviews have focused on either recruitment or retention, highlighting the need to gather experiences to obtain a more comprehensive picture for improving participation in research.

Aim: To share lessons learned about the challenges of recruiting and implementing an intervention study including migrants with type 2 diabetes.

Methods: This was a descriptive study, where researchers recorded experiences in reflective diaries and held discussions with the multi-professional teams involved. Data were analysed using Pawson's conceptual framework, evaluating four dimensions of context: individual, interpersonal, institutional and infrastructural.

Findings: The individual context concerns the time-consuming recruitment process since about half of the prospective participants did not want to participate, often due to illness, lack of time, the need to work, or having travelled abroad. In the interpersonal context, the main challenge was involving several professional groups; the greater the involvement, the less flexibility there was to meet expectations. The priorities in the institutional context were to provide care, with efficiency and productivity taking precedence over research. The infrastructural context was crucial due to a lack of staff available to support recruitment, the healthcare system's burden caused by the pandemic, and the impact of laws and regulations in healthcare.

Conclusions: Recruiting and implementing clinical research studies among migrant populations is complex. Factors across all contextual levels play a role, but the main challenges are within the institutional and infrastructural contexts. Changes in infrastructure influence institutional priorities, particularly with an already strained staff situation in primary healthcare. While political and social changes are difficult to alter, fostering positive attitudes towards research at the individual and interpersonal levels is important.

Aim: This study aimed to assess the prevalence of post-COVID syndrome (PCS) and identify associated risk factors among healthcare workers (HCWs) in a large tertiary care hospital, with the objective of highlighting the importance of preparedness for similar post-viral syndromes in future pandemics.

Background: Post-COVID syndrome, a form of post-viral syndrome, encompasses a range of long-term symptoms affecting multiple organ systems, which can persist after the recovery from COVID-19.

Methods: A cross-sectional study was conducted using an online self-administered survey among HCWs who tested positive for COVID-19 at a large tertiary medical centre in Beirut.

Findings: Among the 134 participants who had experienced COVID-19, nearly half (47.7%) reported symptoms consistent with PCS. Fatigue, shortness of breath, poor memory, and poor concentration were the most frequently reported symptoms, lasting for over three months post-COVID-19 infection in the majority of patients. Direct care of COVID-19 patients and higher severity of acute COVID-19 infection were significantly associated with an increased likelihood of developing PCS. Further research to enhance understanding and management of post-viral syndromes is needed. Additionally, proactive strategies should be implemented to mitigate associated risks in healthcare settings, emphasizing the importance of preparedness for future pandemics.