Primary health care research & development最新文献

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.

Aim: To investigate how to recruit patients rigosrously in general practice for trials based on symptoms as predefined inclusion criteria rather than a well-defined diagnosis. We used persistent physical symptoms (PPS) as a target condition.

Background: Conducting randomized controlled trials (RCTs) in general practice is crucial for evidence-based decision-making and treatment in frontline healthcare. However, recruitment is often challenged in general practice because many patients have vaguely defined conditions, such as PPS.

Methods: We used qualitative semi-structured interviews to explore the perspectives of general practitioners (GPs) on different recruitment scenarios, while paying particular attention to the logistics and feasibility in routine care. A total of 11 GPs from seven clinics were strategically recruited. The GPs were presented with one recruitment scenario (pre-consultation screening) and encouraged to suggest other scenarios. We conducted a thematic framework analysis of the interview material.

Findings: To ensure valid intervention research, one predefined scenario was discussed, and three additional scenarios were co-created during the interviews: (1) opportunistic screening, (2) pre-consultation screening, (3) audit (retrospective and prospective), and (4) random sample screening of the practice population. These scenarios differ with respect to logistical complexity, comparability to daily clinical practice, and entailed selection bias. Every scenario requires individual adaptation and implementation support to be feasible in routine care in general practice. The present study provides approaches for rigorous primary care research based on RCTs for frequent and vaguely defined conditions, but it also highlights a need to develop research methods better suited to frontline healthcare interventions.

Background: Diabetes mellitus is a prevalent chronic illness worldwide and largely impacts migrants who have settled in developed countries. In diabetes care, patients play a central role and are natural partners in self-care education for improving health. Upon reviewing the literature, no studies were found that evaluated culturally adapted education models led by a nurse and delivered by a multi-professional team from the perspective of migrants in a group setting. Therefore, this study aims to explore patients' evaluation of the content and implementation of a person-centred, group-based diabetes education model for migrants with type 2 diabetes led by a nurse and delivered by a multi-professional team.

Method: Qualitative exploratory study, using semi-structured interviews in focus groups and individually to collect data. Eleven migrants who had participated in an intervention testing the education model aged 45-70, who had been living in Sweden between 4-32 years participated. Inductive qualitative content analysis of data was undertaken.

Results: Participants gave a positive picture of their experiences concerning the content and organisation of the person-centred, group-based, culturally adapted diabetes education model. The education sessions were described as providing new and evidence-based knowledge. The multi-professional education staff and the interpreter were perceived as having a professional and familiar approach. They wanted to recommend the education model to others.

Conclusions: The study revealed a well-functioning diabetes education model tailored to individual beliefs and cultural aspects. It improved perceived knowledge about type 2 diabetes among migrants, thus increasing self-care behaviour and health. In today's multicultural society, the study offers insights into migrants' feelings, ideas, concerns, knowledge, and experience regarding the content, structure, and outcome of a group-based, culturally adapted diabetes education model that can improve self-care behaviour to promote health and prevent illness. As a result, the education model can be used in primary healthcare as a central and natural partner in self-care education to improve health.

Aim: In this systematic review, we identify and critically appraise randomised controlled trials of effectiveness of available educational, behavioural, cognitive, and self-management support interventions for individuals with chronic migraine.

Background: Non-pharmacological interventions have the potential to help people living with chronic migraine. Little is known about their true effectiveness.

Methods: We searched Cochrane, Embase, Medline, PsychINFO, Scopus, and Web of Science for randomised controlled trials assessing the effectiveness of educational, behavioural, cognitive, and self-management support interventions, compared to usual care, for adults with chronic migraine. Our outcomes of interest were headache frequency, headache-related disability, quality of life, pain intensity, medication consumption, and psychological wellbeing at baseline and follow-up.

Findings: We included six randomised controlled trials (713 participants) whose interventions met our inclusion criteria: two educational, two psycho-educational, and two behavioural interventions. Trial heterogeneity precluded statistical pooling. Several small trials reported some between-group differences. One trial (N = 177) found more people had ≥50 reduction in headache frequency at 12 months following a psychological (mindfulness-based) intervention added to acute medication withdrawal in people with medication overuse headache: 43/89 (48%) control vs. 69/88 (78%) intervention, p < 0.001. However, the largest included study (N = 396) had effectively excluded the possibility that their intervention had a worthwhile effect on headache-related disability at 12 months; mean difference in Headache Impact Test (HIT-6) 0.7 (95% Confidence Interval -0.65 to 1.97). Current evidence does not support the use of educational, behavioural, cognitive, and self-management support interventions for individuals with chronic migraine to improve headache-related symptoms and quality of life. Very limited evidence suggests they may contribute towards headache frequency reduction.

Background: Rehabilitation with removable complete dentures (RCDs) involves navigating public dental systems that often present barriers like long wait times and limited access. While clinical outcomes are often known, patient experiences with service delivery remain underexplored. Understanding these experiences is key to improving denture care in public settings.

Objectives: This study aimed to explore and gain a comprehensive understanding of the service delivery experiences of patients rehabilitated with RCDs through the public dental health system in the State of Tasmania in Australia with the goal of informing improvements to the patient journey and overall service quality.

Methods: A qualitative study using a Constructivist Grounded Theory (CGT) approach was undertaken. Twenty-five adult participants who received RCDs between 2017 and 2022 were purposively selected from public dental clinics. Data were collected through in-depth, semi-structured, face-to-face interviews. Analysis followed CGT principles, including iterative coding, constant comparison, memo writing, and the co-construction of meaning with participants.

Results: Participants reported emotional distress linked to prolonged waiting times and limited continuity of care. Despite valuing the professionalism and empathy of individual practitioners, many expressed a need for improved communication, more coordinated interdisciplinary care, and greater system responsiveness. Good service was characterised by accessibility, affordability, approachability, friendly staff, and high-quality care. Suggestions for improvement included moving services close to patients, better integration with other health sectors, and the use of visual aids to support understanding and self-management.

Conclusions: Patient narratives reveal a pressing need to address delays, communication gaps, and fragmented care in the public denture service pathway. System-level changes adopting a more holistic approach such as patient-centred approach, improving interprofessional collaboration, decentralising service provision, and enhancing health communication may significantly improve the denture rehabilitation experience and patient outcomes.

Background: The influence of severity of migraine-like symptoms on different levels of executive functions is not well established. In this study, we investigate the impact of severity of migraine-like symptoms on the relationship between core-level executive functions (attention and memory) and fluid intelligence.

Methods: A cross-sectional study was conducted on university students (n = 427, age = 20.7 + 1.8 years). Participants completed self-report measures of Migraine Screen Questionnaire (MS-Q), single-item visual analogue scales (VASs) each for the subjective accounts of problems in core-level executive functions (attention and memory), and a single-item VAS for problems in fluid intelligence (PFI), and sociodemographics tool. The mediation effect model was used to determine the relationship.

Results: The study found a correlation between i) attention problems and severity of migraine-like symptoms (b = 0.109, standard error (SE) = 0.026, p < 0.001), ii) severity of migraine-like symptoms and memory problems (b = 0.318, SE = 0.076, p < 0.001), and iii) severity of migraine-like symptoms - PFI (b = 0.243, SE = 0.083, p < 0.003), with an indirect effect of attention problems on memory problems and PFI and no correlation between severity of migraine-like symptoms and PFI.

Conclusions: Self-reported accounts of problems in core-level executive functions and fluid intelligence are correlated. Severity of migraine-like symptoms may mediate the inter-relationship between some core-level and higher-level executive functions.