Family practice最新文献

{"title":"Primary care insights on the management of diabetes: results from a mixed method study of care changes and impacts during the COVID-19 pandemic.","authors":"Karla Freeman, Shuaib Hafid, Dee Mangin, Andrea Carruthers, Meredith Vanstone, Kris Aubrey-Bassler, Jennifer Lawson, Marie-Thérèse Lussier, Kathryn Nicholson, Neil Drummond, John A Queenan, Michelle Howard","doi":"10.1093/fampra/cmaf027","DOIUrl":"10.1093/fampra/cmaf027","url":null,"abstract":"<p><strong>Background: </strong>In Canada, primary care manages most diabetes care. The COVID-19 pandemic disrupted primary care, reducing access to care and monitoring.</p><p><strong>Objectives: </strong>We aim to describe changes in diabetes monitoring during the first 21 months of the pandemic, patients' experiences with these changes, and impact on HbA1c and blood pressure (BP) control.</p><p><strong>Methods: </strong>We conducted a two-phase mixed methods study: (i) A retrospective pre-post cohort study using de-identified electronic medical record data to compare HbA1c and BP measurement frequency and results in diabetic patients prepandemic (22 June 2018 to 12 March 2020) and during the pandemic (13 March 2020 to 3 December 2021); (ii) A qualitative descriptive analysis using semistructured interviews to understand patient experiences navigating diabetes care during the pandemic.</p><p><strong>Results: </strong>The cohort included 84 617 patients with validated diabetes case definition. Proportion of patients with <1 HbA1c test increased by 10% during the pandemic. For those with ≥1 test, mean HbA1c remained unchanged [mean (SD) HbA1cPre: 7.2 (1.3); HbA1cDuring: 7.2 (1.3); P = .51]. Proportion of patients with <1 BP measurement increased by 23%. For those with ≥1 measurement, mean BP remained clinically similar [mean (SD) sBPPre: 131.8 (13.7); sBPDuring: 132.9 (15.2); P < .01. Mean dBPPre: 74.9 (8.6); dBPDuring: 75.1 (9.1); P = .63]. Nineteen participants were interviewed, discussing virtual care, challenges with self-monitoring, and self-management strategies.</p><p><strong>Conclusions: </strong>Mean HbA1c and BP values remained clinically stable during the pandemic despite reductions in monitoring frequency, likely due to continuity of care and patient self-management. Future research should evaluate a de-intensified frequency of diabetes monitoring and address care gaps.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283096","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":"Effectiveness of interactive dashboards to optimize prescribing in general practice: a systematic review.","authors":"Caroline McCarthy, Patrick Moynagh, Áine Mannion, Ashely Wei, Barbara Clyne, Frank Moriarty","doi":"10.1093/fampra/cmaf036","DOIUrl":"10.1093/fampra/cmaf036","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organisation's Medication Without Harm campaign aims to reduce severe avoidable medication-related harm by 50%. This systematic review explored the characteristics of interventions that provide visual and longitudinal feedback on prescribing (interactive dashboards), in general practice and the effect of these interventions on prescribing-related outcomes.</p><p><strong>Methods: </strong>This systematic review was registered prospectively and reported in line with PRISMA guidelines. Multiple databases and grey literature were searched in November 2023 to identify interventional studies that explored the effect of interactive dashboards on prescribing-related outcomes in general practice. Two independent researchers conducted screening, data extraction, and risk of bias assessment. Interventions were described narratively, and a random-effects meta-analysis was performed for comparable studies.</p><p><strong>Results: </strong>Ten randomized controlled trials, one controlled before-and-after study, and three interrupted time series were included. Seven studies reported a significant positive effect on prescribing-related outcomes, with an effect seen more often for studies focussing on potentially inappropriate prescribing (PIP) (four out of six). Three of the eight studies that focussed on antibiotic prescribing demonstrated a significant effect. A meta-analysis of three RCTs involving 160 general practices and 198 135 patients demonstrated the overall odds of PIP was 0.92 (95%CI: 0.78-1.06, I2 = 70.1%) in the intervention compared to the control group.</p><p><strong>Conclusion: </strong>Interactive dashboards show promise for supporting safe and effective prescribing in general practice, but current evidence is inconclusive. Future research should focus on developing core outcome sets to facilitate future meta-analyses of effectiveness as well as optimizing their implementation and understanding how to sustain user engagement.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215381","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":"Health care experiences of female sex workers: a qualitative study.","authors":"Özlem Kızıltaş, İzzet Fidancı, Hilal Aksoy, Duygu Ayhan Başer","doi":"10.1093/fampra/cmaf048","DOIUrl":"https://doi.org/10.1093/fampra/cmaf048","url":null,"abstract":"<p><strong>Background: </strong>Sex workers face significant barriers to accessing health services, including stigma, economic constraints, and safety concerns. In Turkey, this group is often subjected to discrimination and prejudiced approaches when accessing sexual health services, which reduces the uptake of health services. This study aims to analyze the health care experiences of sex workers in depth.</p><p><strong>Methods: </strong>The study conducted semi-structured in-depth interviews with 16 women working as sex workers in Adana brothel in July-October 2024, and the data were analyzed through thematic analysis. Participants were selected through purposive sampling to ensure socio-demographic diversity.</p><p><strong>Results: </strong>Four main themes were identified through the analysis: Barriers to Access and Use of Health Services, Health Service Experiences and Satisfaction, Information and Awareness, and Emotional Situations. Participants indicated that they often preferred private health facilities due to difficulties in accessing public health services and long waiting times, but that these preferences were limited by cost.</p><p><strong>Conclusions: </strong>Improving the quality of public health services and reducing costs may improve public health by encouraging this group to use health services.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324904","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":"Performance of large language models on family medicine licensing exams.","authors":"Mahmud Omar, Kareem Hijazi, Mohammad Omar, Girish N Nadkarni, Eyal Klang","doi":"10.1093/fampra/cmaf035","DOIUrl":"https://doi.org/10.1093/fampra/cmaf035","url":null,"abstract":"<p><strong>Background and aim: </strong>Large language models (LLMs) have shown promise in specialized medical exams but remain less explored in family medicine and primary care. This study evaluated eight state-of-the-art LLMs on the official Israeli primary care licensing exam, focusing on prompt design and explanation quality.</p><p><strong>Methods: </strong>Two hundred multiple-choice questions were tested using simple and few-shot Chain-of-Thought prompts (prompts that include examples which illustrate reasoning). Performance differences were assessed with Cochran's Q and pairwise McNemar tests. A stress test of the top performer (openAI's o1-preview) examined 30 selected questions, with two physicians scoring explanations for accuracy, logic, and hallucinations (extra or fabricated information not supported by the question).</p><p><strong>Results: </strong>Five models exceeded the 65% passing threshold under simple prompts; seven did so with few-shot prompts. o1-preview reached 85.5%. In the stress test, explanations were generally coherent and accurate, with 5 of 120 flagged for hallucinations. Inter-rater agreement on explanation scoring was high (weighted kappa 0.773; Intraclass Correlation Coefficient (ICC) 0.776).</p><p><strong>Conclusions: </strong>Most tested models performed well on an official family medicine exam, especially with structured prompts. Nonetheless, multiple-choice formats cannot address broader clinical competencies such as physical exams and patient rapport. Future efforts should refine these models to eliminate hallucinations, test for socio-demographic biases, and ensure alignment with real-world demands.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247200","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 Brain Care Score and its associations with cardiovascular disease and cancer.","authors":"Jasper R Senff, Cyprien A Rivier, Reinier Tack, Benjamin Y Q Tan, Tamara N Kimball, Hens Bart Brouwers, Amy Newhouse, Gregory Fricchione, Rudolph E Tanzi, Nirupama Yechoor, Zeina Chemali, Christopher D Anderson, Jonathan Rosand, Guido J Falcone, Sanjula Singh","doi":"10.1093/fampra/cmaf034","DOIUrl":"https://doi.org/10.1093/fampra/cmaf034","url":null,"abstract":"<p><strong>Background: </strong>The Brain Care Score (BCS) was developed in partnership with patients and practitioners to convey actionable knowledge to individuals everywhere that can motivate change in health-related behaviors and thereby reduce the risk of dementia, stroke, and late-life depression (LLD). Because diseases outside the brain share modifiable risk factors with dementia, stroke, and LLD, we investigated the associations of the BCS with other common age-related diseases, including cardiovascular disease (CVD) and cancer.</p><p><strong>Methods: </strong>Among all UK Biobank (UKB) participants with complete BCS data, we performed Cox proportional hazard regression analyses between the BCS at baseline and incident CVD (ischemic heart disease, stroke, and heart failure) and the three most common cancer types (lung, colorectal, and breast cancer), adjusted for sex and stratified by age.</p><p><strong>Results: </strong>Among 416 370 UKB participants (mean age: 57 years; 54% female), 33 944 cases of CVD (8.8%) and 16 090 cases of cancer (4.0%) were identified over a median follow-up of 12.5 years. A 5-point higher BCS at baseline was associated with a lower incidence of CVD (hazard ratio [HR]: 0.57 [95% confidence interval {95% CI}: 0.55-0.59]) and lower incidence of the three most common cancer types (HR: 0.69 [95% CI: 0.66-0.72]).</p><p><strong>Conclusions: </strong>A higher BCS at baseline is associated with a lower incidence of CVD and three cancer types. Although developed specifically as an actionable tool to guide individuals in reducing their risk of common age-related brain diseases, we show that it may also offer ancillary benefits, providing a single place to start for guiding individuals toward improving their chances of healthy aging more generally.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215310","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":"Getting started with search filters in primary care literature reviews.","authors":"Thomas Morel, Vera Granikov, Ambar Kulshreshtha, Richard Young, Jean-Pascal Fournier","doi":"10.1093/fampra/cmaf037","DOIUrl":"10.1093/fampra/cmaf037","url":null,"abstract":"<p><p>Primary care researchers and clinicians are facing an ever-growing evidence base, more options to access research evidence, and increasingly limited time. Incorporating search filters into primary care systematic reviews can significantly improve the efficiency and confidence of the search process. Search filters, or hedges, are predeveloped search strategies that combine controlled vocabulary and free text terms using Boolean operators (words like \"AND,\" \"OR\"). Search filters help to manage the diverse terminology in the literature, such as the various synonyms for primary care, and can be tailored to the specific needs of the review, whether it aims to be exhaustive or more focussed. Resources such as specialized librarians, databases such as PubMed, and repositories such as the InterTASC Information Specialists Sub-Group provide access to these valuable tools. However, as primary care terminology continues to evolve, regular updates to these filters are necessary to maintain their relevance and effectiveness. This method brief presents search filters and highlights their value for finding research literature in primary care.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283095","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":"Adherence to antibiotic prescribing guidelines in Dutch primary care: an analysis of national prescription data on ear and respiratory tract symptoms and conditions among 384 general practices.","authors":"Maarten Lambert, Renee Veldkamp, Yvette Weesie, Anke Lambooij, Jochen W L Cals, Katja Taxis, Liset van Dijk, Karin Hek","doi":"10.1093/fampra/cmaf031","DOIUrl":"10.1093/fampra/cmaf031","url":null,"abstract":"<p><strong>Background: </strong>Mapping general practitioners' antibiotic prescribing practices is essential to optimize antibiotic use in primary care and mitigate antibiotic resistance.</p><p><strong>Objectives: </strong>The objective of this study was to examine the adherence of Dutch general practitioners to prescribing guidelines for ear and respiratory tract symptoms and conditions.</p><p><strong>Methods: </strong>A cross-sectional study was conducted on Dutch electronic health records from 2018 to 2021. Antibiotic prescribing frequency and type were examined for ear and respiratory tract symptoms and conditions based on professional prescribing guidelines. Descriptive statistics and multilevel logistic regression analyses were applied.</p><p><strong>Results: </strong>Patient records from up to 384 general practices were analysed for 15 ear and 27 respiratory tract conditions. For 11 of the 15 (73%) ear and 17 of the 27 (63%) respiratory tract conditions, more than 95% of patients were treated according to the prescribing guidelines. Most potential non-adherence to antibiotic prescribing guidelines occurred for acute otitis media (31%-34%), acute bronchitis/bronchiolitis (26%-39%), and acute sinusitis (25%-34%). Several other respiratory tract conditions showed non-indicated prescribing rates above 10%. For otitis externa, many broad-spectrum antibiotics were prescribed, which rarely happened for respiratory conditions. High variation in prescribing frequency and type between general practices occurred.</p><p><strong>Conclusions: </strong>For most conditions, Dutch general practitioners adhere well to antibiotic prescribing guidelines. There are conditions for which there is a high potential for inappropriate prescribing. High variation between practices suggests room for improvement. Stricter implementation of prescribing guidelines may help improve prescribing practice. Alternatively, a practice-specific approach could be effective. The Dutch setting may be exemplary for international antibiotic prescribing practice.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283094","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":"Risk factors and outcomes of not having a preferred doctor: a cross-sectional study based on data from the French main health insurance scheme.","authors":"Jérôme Tourasse, Annaëlle Testud, Cyrille Colin, Marie Viprey, Laurent Letrilliart","doi":"10.1093/fampra/cmaf008","DOIUrl":"https://doi.org/10.1093/fampra/cmaf008","url":null,"abstract":"<p><strong>Background: </strong>In France, 90.1% of the population was registered with a preferred doctor in 2019.</p><p><strong>Objectives: </strong>To explore the risk factors and healthcare utilization associated with not being registered with a preferred doctor.</p><p><strong>Design and setting: </strong>Population-based cross-sectional study conducted among insured individuals aged 16 years or above in the Lyon metropolitan area.</p><p><strong>Methods: </strong>Data was extracted from the French health insurance information system for the year 2019. Univariate and multivariate models were used to analyse the risk factors and healthcare utilization associated with not being registered with a preferred doctor.</p><p><strong>Results: </strong>Among 878 030 individuals, 12.2% were not registered with a preferred doctor. In multivariate analysis, individuals not registered with a preferred doctor were younger (OR up to 18.2 between 16 and 30 years, compared to those aged ≥ 75 years), more often male (OR = 1.13), lived more often in a high medical accessibility area (OR up to 1.13 in the fourth quartile, compared to the first quartile), had less often a low income (OR = 0.64) or a long-term condition status (OR = 0.30), than those registered. Individuals without a preferred doctor had fewer visits to a GP (OR = 0.09), to a specialist (OR = 0.15), and to an emergency department (OR = 0.35), fewer hospitalizations (OR for no hospitalization = 4.54), and fewer selected prevention procedures (OR as low as 0.06 for breast cancer screening).</p><p><strong>Conclusions: </strong>Not having a preferred doctor may limit access to primary and secondary care. Strategies to enhance registration should be considered, particularly for individuals with a long-term condition and those living in medically underserved areas.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283097","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":"Why do we still think cancer control is a one-time event?","authors":"Waseem Jerjes","doi":"10.1093/fampra/cmaf044","DOIUrl":"https://doi.org/10.1093/fampra/cmaf044","url":null,"abstract":"","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283099","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":"Risk of refeeding syndrome: an observational study in primary healthcare.","authors":"Clément de Begon de Larouzière de Montlosier, Candy Guiguet-Auclair, Pierre Mély, David Julien, Laurent Gerbaud, Marie Blanquet","doi":"10.1093/fampra/cmaf038","DOIUrl":"https://doi.org/10.1093/fampra/cmaf038","url":null,"abstract":"<p><strong>Background: </strong>Refeeding syndrome (RFS) is a complex phenomenon associated with increased mortality. However, the prevalence of risk factors for RFS has never been assessed in primary care. Our aim was to assess the prevalence of risk for developing RFS in primary care.</p><p><strong>Methods: </strong>A retrospective observational study was conducted in a general practitioner (GP) surgery in June 2022. The study included older adult patients (aged ≥75 years) or adult patients with chronic disease (aged 18-74 years), living at home and receiving care at home or at the GP's surgery between January 1 and June 30, 2021. Patients at high risk of developing RFS were identified using the National Institute for Health and Clinical Excellence (NICE) criteria. The risk of RFS was also assessed in patients aged ≥70 years using an adaptation of the NICE criterion for body mass index based on the Global Leadership Initiative on Malnutrition guidelines.</p><p><strong>Results: </strong>The prevalence of patients at risk for RFS was 2.8% (95% CI: 1.5%-4.1%) in the full population of 611 patients and 8.8% (95% CI: 6.1%-6.4%) in the subset of patients aged ≥70 years assessed using the adapted NICE criterion. The prevalence of patients at risk for RFS increased with age and chronic conditions. More severe comorbidity and home care were factors associated with higher risk of RFS.</p><p><strong>Conclusion: </strong>The risk of developing RFS in primary care settings is not negligible. GPs should consider this risk in their practice to develop a more comprehensive care programme.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283098","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}