Family practice最新文献

{"title":"The extent and improvement of patient complexity in referrals to hospital family physicians from community healthcare-related centers in Japan: a retrospective cohort study.","authors":"Junki Mizumoto, Yumiko Hironaka, Hirohisa Fujikawa","doi":"10.1093/fampra/cmaf026","DOIUrl":"https://doi.org/10.1093/fampra/cmaf026","url":null,"abstract":"<p><strong>Background: </strong>Hospital family physicians are recognized for their excellence in managing complex issues. This study aimed to reveal the level of complexities of patients referred to hospital family physicians by community centers, and the degree of change in these complexities following care provided by a health care team that includes hospital family physicians.</p><p><strong>Methods: </strong>A retrospective cohort analysis. Patients introduced by community centers between 2020 and 2023 were identified. The patients received team-based comprehensive care. Complexity was calculated before and after the care, using the patient-centered assessment method (PCAM), which evaluates 12 items across four domains. Each item is rated from 1 to 4, yielding a total score range of 12 to 48. Pre- and post-intervention scores were compared using paired-sample t-tests, with standardized mean difference calculated using Hedges' g.</p><p><strong>Results: </strong>Of 41 referred patients, three died shortly after the initial consultation. Among the 38 remaining patients, 24 were admitted, and 14 were treated as outpatients. The mean PCAM score significantly decreased from 36.9 to 23.7 after interventions (P < .001, Hedges' g = 2.54). Scores improved significantly across all domains: health and well-being (2.96 vs 1.95; P < .001, g = 2.00), social environment (3.09 vs 1.96; P < .001, g = 2.38), health literacy and communication (2.78 vs 2.46; P < .001, g = 0.67), and service coordination (3.61 vs 1.57; P < .001, g = 4.68).</p><p><strong>Conclusion: </strong>Hospital family physicians in Japan often manage patients with exceptionally complex problems and improve patient outcomes across multiple domains.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The implementation and evaluation of the Ontario COVID@Home Clinical Primary Care Pathway.","authors":"Dee Mangin, Jennifer Salerno, Rebecca Clark, Julie Datta, Jennifer Lawson, Mara Dempsey, Dawn Elston, Shuaib Hafid, David Price, David Kaplan, Cathy Risdon, Casey Irvin, Erin Beaulieu","doi":"10.1093/fampra/cmaf022","DOIUrl":"10.1093/fampra/cmaf022","url":null,"abstract":"<p><strong>Background: </strong>The COVID@Home Clinical Care Pathway (the Pathway) was developed and implemented as an evidence-based remote monitoring clinical care pathway for the integrated management of coronavirus disease 2019 (COVID-19) in the province of Ontario, Canada. We examine its effectiveness and rapid large-scale implementation.</p><p><strong>Methods: </strong>Using a prospective longitudinal study design, we used electronic medical record clinical data, provider and patient surveys, web analytics, healthcare and provincial utilization, and government holdings data to evaluate reach, effectiveness, adoption, implementation, and maintenance outcomes, including patient mortality and health equity.</p><p><strong>Results: </strong>The Pathway was widely accessed (19 474 Ontario unique users), contributed 28 816 oxygen saturation monitors, and achieved coverage across income levels and geography. Two-thirds of patients had > 1 encounter, monitored for a median of 4 days (Range: 1-57). Fifty percent of patients had > 1 chronic condition. Patients receiving Pathway care were less likely to die by 0.44% (20/4556), two times lower compared to the total mortality of a population-based representative patient cohort over a parallel time period in Ontario of 0.86% (1820/212 326, P = .0023). Patients were very satisfied with their care, and felt care was accessible, safe, and clear. Providers were very satisfied with the Pathway resources and reported strengthened relationships across the health system.</p><p><strong>Conclusions: </strong>Primary care (PC) rapidly implemented a clinical care pathway during the COVID-19 crisis. The Pathway demonstrated the beneficial role and effectiveness of PC when patients are provided with timely, accessible, and comprehensive care. Public health responses should explicitly collaborate with PC to address population health.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges of the primary healthcare system of the Philippines: addressing the barriers to effective healthcare delivery for lesbian, gay, bisexual, transgender, queer, and other identities(LGBTQ+) people.","authors":"Rowalt Alibudbud","doi":"10.1093/fampra/cmaf028","DOIUrl":"https://doi.org/10.1093/fampra/cmaf028","url":null,"abstract":"<p><p>Challenges related to healthcare financing, service availability, accessibility, workforce, and information systems can hinder the implementation and delivery of primary care services, particularly for Lesbian, Gay, Bisexual, Transgender, Queer, and other sexual and gender minority individuals in developing countries like the Philippines. Addressing these issues requires a collaborative, multi-sectoral approach involving government agencies, private sector partners, and community stakeholders.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between physician salary and competitiveness of that specialty in the match: money still matters.","authors":"Mark H Ebell, Julie P Phillips","doi":"10.1093/fampra/cmaf021","DOIUrl":"https://doi.org/10.1093/fampra/cmaf021","url":null,"abstract":"<p><strong>Introduction: </strong>Given high levels of student debt and a desire for high income, we hypothesize that the mean salary of a medical specialty is correlated with how desirable that specialty is for graduating US medical students.</p><p><strong>Methods: </strong>We used salary data from a 2024 survey of 33,000 US physicians. As a proxy for desirability or competitiveness, we used the percentage of year 1 positions filled with US allopathic seniors based on data from the National Residency Match Program. Scatter plots were created and Pearson correlation coefficients were calculated.</p><p><strong>Results: </strong>There was a strong positive correlation between salary and competitiveness for US allopathic seniors (r = + 0.65). A negative correlation was seen for US osteopathic seniors (r = -0.53) and international medical graduates (r = -0.58).</p><p><strong>Conclusions: </strong>A specialty's salary is strongly associated with its competitiveness for US allopathic seniors. Data for osteopathic seniors and international graduates shows the opposite association, suggesting a channeling bias of these students into lower-paying specialties or more successful efforts to encourage primary care careers.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher person-centered primary care measure score is associated with better influenza vaccine uptake: a nationwide cross-sectional study.","authors":"Makoto Kaneko, Hironori Yamada, Tadao Okada","doi":"10.1093/fampra/cmaf030","DOIUrl":"https://doi.org/10.1093/fampra/cmaf030","url":null,"abstract":"<p><strong>Background: </strong>Patient experience (PX) is one of the important primary care (PC) indicators. Therefore, PX measurement is essential for assessing PC quality. However, no single standard measure has been established. Although the Person-Centered Primary Care Measure (PCPCM) is a comprehensive and concise measure for evaluating PX in PC, the association between the score and clinical outcomes remains unclear.</p><p><strong>Objective: </strong>This study aimed to assess the association between the PCPCM score and influenza vaccine uptake, an important clinical outcome in PC for all ages.</p><p><strong>Methods: </strong>This nationwide cross-sectional study conducted in 2022 used an online survey with stratified random sampling in Japan. PX in PC was evaluated using the PCPCM. The outcome variable was influenza vaccine uptake in the past year. A modified Poisson regression analysis was conducted to investigate the relationship between the PCPCM score and influenza vaccine uptake to adjust for possible confounders.</p><p><strong>Results: </strong>Among 1112 potential participants, 800 responded; 32.4% received influenza vaccination. After adjusting for possible confounders, PX was found to be associated with influenza vaccine uptake (risk ratio [RR] = 2.02, 95% confidence interval [CI], 1.51-2.70 for the highest score quartile, compared with no usual source of care). The relationship between the PCPCM score quartile and vaccine uptake was dose-dependent.</p><p><strong>Conclusions: </strong>A higher PCPCM score was associated with better influenza vaccine uptake. Because the PCPCM is a concise and validated measure of PX in PC and has been translated into many languages, the results provide important evidence to promote the measurement of PX in PC worldwide.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of caregiver and family interventions on patients with common mental health problems in primary care: a systematic review.","authors":"Felix Bader, Linda Sanftenberg, Gabriele Pitschel-Walz, Caroline Jung-Sievers, Tobias Dreischulte, Jochen Gensichen","doi":"10.1093/fampra/cmaf017","DOIUrl":"10.1093/fampra/cmaf017","url":null,"abstract":"<p><strong>Background and objectives: </strong>Common mental health problems are often diagnosed and treated by primary care physicians, who take care of entire families. Therefore, the methods of primary care interventions involving informal caregivers and their effects on the mental health outcomes of the care recipients suffering from symptoms of depression, anxiety, obsessive-compulsive disorder, or post-traumatic stress disorder shall be examined.</p><p><strong>Methods: </strong>A systematic literature search was performed in the databases PubMed, Cochrane Library, EMBASE, APA PsycInfo, APA PsycArticles, and PSYNDEX in August 2023 and January 2025. The trial registries International Clinical Trials Registry Platform (ICTRP), clinicaltrials.gov, and the German Clinical Trials Register (DRKS) were searched in October 2023. Clinical trials examining the effects of caregiver interventions in primary care on medical outcomes for patients suffering from symptoms of the common mental health problems in focus were included (PROSPERO: CRD42023460471).</p><p><strong>Results: </strong>A total of 8825 studies were identified. Two randomized controlled studies, two non-randomized controlled studies, and two study protocols for randomized controlled trials (RCTs) met the inclusion criteria. Interventions in three of four studies revealed improved mental health outcomes in patients. Core elements of these studies contain self-management with the use of information technology, psychoeducation, and peer support. One study did not reveal significant improvements compared to control.</p><p><strong>Conclusions: </strong>The review indicates, that there can be a potential positive effect of informal caregiver involvement on patients` mental health outcomes. Application of information technology might be useful to manage time invest. Potential methods can be self-management, psychoeducation, and peer support. Further evidence generation in primary care is needed for more solid conclusions.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Australian practice nurses' perspectives on integrating specialist diabetes care with primary care: a qualitative study.","authors":"Rachael M Taylor, Shamasunder H Acharya, Martha E Parsons, Ushank P Ranasinghe, Deniz O Kuzulugil, Kerry C Fleming, Melissa L Harris, Julie E Byles, Annalise N Philcox, Meredith A Tavener, John R Attia, Johanna Kuehn, Sharon N Ross-Evans, Alexis J Hure","doi":"10.1093/fampra/cmaf020","DOIUrl":"https://doi.org/10.1093/fampra/cmaf020","url":null,"abstract":"<p><strong>Background: </strong>In 2015, the Australian Diabetes Alliance Program (DAP) was implemented in the Hunter New England Local Health District, New South Wales as a collaboration with the Hunter Medicare Local. DAP integrates specialist teams within primary care practices, delivering case conferencing, practice performance reviews, and education sessions.</p><p><strong>Objective: </strong>To report on practice nurses (PNs) perspectives on the impact of the DAP on their skills, knowledge, and approach in delivering care for adults with type 2 diabetes.</p><p><strong>Methods: </strong>Three primary care practices with high rates of monitoring haemoglobin A1c (HbA1c) levels (> 90% of patients annually) and three practices with lower rates of monitoring HbA1c levels (< 80% of patients annually) from DAP provided the sampling frame. Interviews were conducted with six PNs, which were transcribed and analysed using codebook thematic analysis.</p><p><strong>Results: </strong>Overall, DAP was viewed favourably by PNs. Significant improvements in knowledge and skills were reported relating to administering antihyperglycemic agents, insulin, and other injectable therapy, as well as dietary modifications for diabetes management. PNs transferred this knowledge and skills to other patients not participating in DAP. An improvement in the delivery of diabetes care, rather than a change in approach, was also reported by PNs. However, the amount of preparation required for case conferencing in the program was identified as a burden to PNs.</p><p><strong>Conclusions: </strong>PNs were supportive of DAP and identified knowledge gains that were transferable to other patients. The administrative burdens on PNs need to be considered for scalability of the program.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of anti-M antibody during pregnancy: a case report.","authors":"Emily R Leibovitch, Robert T Carlisle","doi":"10.1093/fampra/cmad067","DOIUrl":"10.1093/fampra/cmad067","url":null,"abstract":"<p><strong>Background: </strong>Anti-M antibodies are relatively common and naturally occurring. When anti-M antibodies cross the placenta, they may cause hemolytic disease of the fetus and newborn (HDFN). Anti-M antibodies account for less than 15 cases of HDFN reported in the published English literature. HDFN can lead to foetal anaemia, hydrops fetalis, hypoxia, heart failure, and even death.</p><p><strong>Objective: </strong>To review the general guidelines and propose a less intensive management approach of anti-M antibody during pregnancy through the context of a case report.</p><p><strong>Methods: </strong>We report a 25-year-old healthy pregnant G3P1011 woman presenting for antepartum care. At the time of delivery for the patient's second pregnancy, she was found to have a positive anti-M blood screen, though she birthed a healthy-term infant. For her current pregnancy, the initial and repeat testings for anti-M were positive.</p><p><strong>Results: </strong>Since multiple samples from this patient were of low levels extensive maternal and foetal monitoring were deemed unnecessary in reflection of further reading and research. The patient had a spontaneous vaginal delivery of her third pregnancy at 38 weeks without complications.</p><p><strong>Conclusion: </strong>Anti-RBC antibodies, including anti-M, are frequently identified in blood type and screening for pregnant patients. Guidelines call for intensive surveillance during pregnancy; however, knowledge of the specific antibody can help to provide more nuanced and less intensive care. As primary care physicians, being familiar with the guideline and the ability to counsel patients on anticipated care during pregnancy can help with family planning, compliance with testing, and patient anxiety and decrease intensive use of services that may not affect outcomes.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9782923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statins for primary prevention in multimorbid patients: to prescribe or not to prescribe? A qualitative analysis of general practitioners' decision-making processes.","authors":"Racha Onaisi, Anaïs Bezzazi, Thomas Berthouin, Justine Boulet, Jennifer Hasselgard-Rowe, Hubert Maisonneuve","doi":"10.1093/fampra/cmad068","DOIUrl":"10.1093/fampra/cmad068","url":null,"abstract":"<p><strong>Introduction: </strong>A better understanding of the determinants involved in general practitioners' (GPs) decision-making processes when it comes to prescribing statins as primary prevention in patients with multimorbidity could provide insights for improving implementation of primary prevention guidelines.</p><p><strong>Methods: </strong>We conducted a qualitative study using a deductive framework-based and inductive analysis of GPs' semi-structured interviews verbatim, from which expertise profiles of prescribers were also drawn. The analytical framework was built from a pragmatic synthesis of the evidence-based medicine, Modelling using Typified Objects (MOT) model of clinical reasoning processes, Theoretical Domains Framework, and shared decision-making frameworks.</p><p><strong>Results: </strong>Fifteen GPs were interviewed between June 2019 and January 2020. Diabetes seemed to represent a specific motivation for deciding about statin prescription for primary prevention purposes; and in situations of multimorbidity, GPs differentiated between cardiovascular and non-cardiovascular multimorbidity. Expert prescribers seemed to have integrated the utilisation of cardiovascular risk calculation scores throughout their practice, whereas non-expert prescribers considered them difficult to interpret and preferred using more of a \"rule of thumb\" process. One interviewee used the risk calculation score as a support for discussing statin prescription with the patient.</p><p><strong>Conclusion: </strong>Our results shed light on the reasons why statins remain under-prescribed for primary prevention and why non-diabetic multimorbid patients have even lower odds of being prescribed a statin. They call for a change in the use of risk assessment scores, by placing them as decision aids, to support and improve personalised shared decision-making discussions as an efficient approach to improve the implementation of recommendations about statins for primary prevention.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9831704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new community-based cardiopulmonary resuscitation training program for primary care: needs assessment, development, and pilot testing.","authors":"Sandra Paredes-García, Nuria López-Batet, Francesc Carmona, Antoni Sisó-Almirall, Luis González-de Paz","doi":"10.1093/fampra/cmaf019","DOIUrl":"https://doi.org/10.1093/fampra/cmaf019","url":null,"abstract":"<p><strong>Objective: </strong>The general population's interest in cardiopulmonary resuscitation (CPR) remains largely unknown. Fewer than one-third of individuals are familiar with CPR, and there are no comprehensive training programs available. This study aimed to examine CPR interest among patients visited in the primary care setting, design a new program, and assess the feasibility and efficacy of the training initiative.</p><p><strong>Methods: </strong>This two-phase project aimed to (i) examine patients' knowledge and interests and (ii) design and evaluate a training program within the PC setting. Knowledge and interests were assessed using a survey. The training program design adhered to European guidelines. The pilot study assessed effectiveness through self-administered tests, instructor evaluation of the chain of survival, correct use of an automated external defibrillator (AED), and a manikin capable of measuring chest compression.</p><p><strong>Results: </strong>A total of 243 patients participated. Among them, 26.16% had received prior CPR training, only 5% knew how to perform CPR maneuvers, and 84.8% were interested in learning. A 90-min training program was designed. After the training session (N = 50), all participants reported feeling capable of performing CPR techniques using the AED; 94% demonstrated proficiency in AED use, and 20% performed high-quality chest compressions (correct release, depth, and rate).</p><p><strong>Conclusion: </strong>The general population had limited knowledge about CPR but was highly interested in acquiring CPR skills. The PC-based training program enabled bystanders to perform CPR and use AEDs, potentially improving survival rates in out-of-hospital cardiac arrests.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}