Family practice最新文献

{"title":"Lay and general practitioner attitudes towards endometrial cancer prevention: a cross-sectional study.","authors":"Sarah J Kitson, Urwaa Khan, Emma J Crosbie","doi":"10.1093/fampra/cmad076","DOIUrl":"10.1093/fampra/cmad076","url":null,"abstract":"<p><strong>Background: </strong>Effective and targeted endometrial cancer prevention strategies could reduce diagnoses by 60%. Whether this approach is acceptable to individuals and general practitioners (GPs) is currently unknown. This study sought to determine attitudes towards the provision of personalised endometrial cancer risk assessments and the acceptability of potential prevention strategies.</p><p><strong>Methods: </strong>Specific online questionnaires were developed for individuals aged 45-60 years with a uterus and UK-practising GPs, with social media, charity websites, and email used to advertise the study. Individuals completed the questionnaires between February and April 2022.</p><p><strong>Results: </strong>Of 660 lay questionnaire respondents, 90.3% (n = 596) thought that undergoing an endometrial cancer risk assessment was a good or very good idea and 95.6% (n = 631) would be willing to undergo such an assessment. The commonest reasons for wanting to participate were \"to try and reduce my risk\" (n = 442, 67.0%), \"to be informed\" (n = 354, 53.6%), and \"it could save my life' (n = 315, 47.7%). Over 80% of respondents would make lifestyle changes to reduce their endometrial cancer risk (n = 550), with half accepting a pill, Mirena, or hysterectomy for primary prevention. GPs were similarly engaged, with 93.0% (n = 106) willing to offer an endometrial cancer risk assessment if a tool were available, potentially during a Well Woman screen.</p><p><strong>Conclusion: </strong>Personalised endometrial cancer risk assessments are acceptable to potentially eligible individuals and GPs and could be accommodated within routine practice. Clinical trials to determine the effectiveness of lifestyle modification and Mirena for endometrial protection are urgently required and should be targeted at those at greatest disease risk.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"949-955"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11636559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9888141","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":"Measurement of treatment burden in patients with multimorbidity in the Netherlands: translation and validation of the Multimorbidity Treatment Burden Questionnaire (NL-MTBQ).","authors":"Loes W S Engels, Tiny van Merode, Monique Heijmans, Juliane Menting, Polly Duncan, Jany Rademakers","doi":"10.1093/fampra/cmad100","DOIUrl":"10.1093/fampra/cmad100","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity is a growing problem. The number and complexity of (non-)pharmaceutical treatments create a great burden for patients. Treatment burden refers to the perception of the weight of these treatments, and is associated with multimorbidity. Measurement of treatment burden is of great value for optimizing treatment and health-related outcomes.</p><p><strong>Objective: </strong>We aim to translate and validate the Multimorbidity Treatment Burden Questionnaire (MTBQ) for use in the Dutch population with multimorbidity and explore the level of treatment burden.</p><p><strong>Methods: </strong>Translating the MTBQ into Dutch included forward-backward translation, piloting, and cognitive interviewing (n = 8). Psychometric properties of the questionnaire were assessed in a cross-sectional study of patients with multimorbidity recruited from a panel in the Netherlands (n = 959). We examined item properties, dimensionality, internal consistency reliability, and construct validity. The level of treatment burden in the population was assessed.</p><p><strong>Results: </strong>The mean age among 959 participants with multimorbidity was 69.9 (17-96) years. Median global NL-MTBQ score was 3.85 (interquartile range 0-9.62), representing low treatment burden. Significant floor effects were found for all 13 items of the instrument. Factor analysis supported a single-factor structure. The NL-MTBQ had high internal consistency (α = 0.845), and provided good evidence on the construct validity of the scale.</p><p><strong>Conclusion: </strong>The Dutch version of the 13-item MTBQ is a single-structured, valid, and compact patient-reported outcome measure to assess treatment burden in primary care patients with multimorbidity. It could identify patients experiencing high treatment burden, with great potential to enhance shared decision-making and offer additional support.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"901-908"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11636562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50161164","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":"Financial barriers to primary health care in Aotearoa New Zealand.","authors":"Mona Jeffreys, Lis Ellison-Loschmann, Maite Irurzun-Lopez, Jacqueline Cumming, Fiona McKenzie","doi":"10.1093/fampra/cmad096","DOIUrl":"10.1093/fampra/cmad096","url":null,"abstract":"<p><strong>Background: </strong>In Aotearoa New Zealand, co-payments to see a general practitioner (GP, family doctor) or collect a prescription are payable by virtually all adults.</p><p><strong>Objective: </strong>To examine the extent to which these user co-payments are a barrier to accessing health care, focussing on inequities for indigenous Māori.</p><p><strong>Methods: </strong>Pooled data from sequential waves (years) of the New Zealand Health Survey, 2011/12 to 2018/19 were analysed. Outcomes were self-reported cost barriers to seeing a GP or collecting a prescription in the previous year. Logistic regression was used to estimate odds ratios (ORs) of barriers to care for Māori compared with non-Māori, sequentially adjusting for additional explanatory variables.</p><p><strong>Results: </strong>Pooled data included 107,231 people, 22,292 (21%) were Māori. Across all years, 22% of Māori (13% non-Māori) experienced a cost barrier to seeing a GP, and 14% of Māori (5% non-Māori) reported a cost barrier to collecting a prescription. The age- and wave-adjusted OR comparing Māori/non-Māori was 1.71 (95% confidence interval [CI]: 1.61, 1.81) for the cost barrier to primary care and 2.97 (95% CI: 2.75, 3.20) for the cost barrier to collecting prescriptions. Sociodemographics accounted for about half the inequity for both outcomes; in a fully adjusted model, age, sex, low income, and poorer underlying health were determinants of both outcomes, and deprivation was additionally associated with the cost barrier to collecting a prescription but not to seeing a GP.</p><p><strong>Conclusions: </strong>Māori experience considerable inequity in access to primary health care; evidence supports an urgent need for change to system funding to eliminate financial barriers to care.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"995-1001"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11636556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10215537","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":"Adoption, acceptance, and use of a decision support tool to promote timely investigations for cancer in primary care.","authors":"Sophie Chima, Barbara Hunter, Javiera Martinez-Gutierrez, Natalie Lumsden, Craig Nelson, Jo-Anne Manski-Nankervis, Jon Emery","doi":"10.1093/fampra/cmae046","DOIUrl":"10.1093/fampra/cmae046","url":null,"abstract":"<p><strong>Background: </strong>The complexities of diagnosing cancer in general practice has driven the development of quality improvement (QI) interventions, including clinical decision support (CDS) and auditing tools. Future Health Today (FHT) is a novel QI tool, consisting of CDS at the point-of-care, practice population-level auditing, recall, and the monitoring of QI activities.</p><p><strong>Objectives: </strong>Explore the acceptability and usability of the FHT cancer module, which flags patients with abnormal test results that may be indicative of undiagnosed cancer.</p><p><strong>Methods: </strong>Interviews were conducted with general practitioners (GPs) and general practice nurses (GPNs), from practices participating in a randomized trial evaluating the appropriate follow-up of patients. Clinical Performance Feedback Intervention Theory (CP-FIT) was used to analyse and interpret the data.</p><p><strong>Results: </strong>The majority of practices reported not using the auditing and QI components of the tool, only the CDS which was delivered at the point-of-care. The tool was used primarily by GPs; GPNs did not perceive the clinical recommendations to be within their role. For the CDS, facilitators for use included a good workflow fit, ease of use, low time cost, importance, and perceived knowledge gain. Barriers for use of the CDS included accuracy, competing priorities, and the patient population.</p><p><strong>Conclusions: </strong>The CDS aligned with the clinical workflow of GPs, was considered non-disruptive to the consultation and easy to implement into usual care. By applying the CP-FIT theory, we were able to demonstrate the key drivers for GPs using the tool, and what limited the use by GPNs.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"1048-1057"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11642683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461443","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":"Dealing with the doctor shortage: a qualitative study exploring French general practitioners' lived experiences, difficulties, and adaptive behaviours.","authors":"Hélène Dumesnil, Romain Lutaud, Julien Bellon-Curutchet, Aliénor Deffontaines, Pierre Verger","doi":"10.1093/fampra/cmae017","DOIUrl":"10.1093/fampra/cmae017","url":null,"abstract":"<p><strong>Context: </strong>The shortage of general practitioners (GPs) is a growing concern in Europe, especially in France. This problem is likely to continue until the end of the 2020s.</p><p><strong>Objectives: </strong>To study the GPs' perceptions of access to care in medically underserved areas (i.e. with low physician density), its consequences on their working conditions, and how they cope with the resulting difficulties.</p><p><strong>Methods: </strong>Semi-structured individual interviews were conducted between May and August 2021 of 29 GPs practising in areas of southeastern France with a low physician density or at risk of a doctor shortage. Purposive sampling was used to include profiles of diverse physicians and diverse rural and urban areas. The interviews, conducted with an interview guide, were transcribed and analysed thematically.</p><p><strong>Results: </strong>The participants described a serious degradation of access to care in their areas. These issues also concerned urban areas, where they were, according to the participants, underrecognized. The participants' workloads were rising, at a rate often perceived as unsustainable: many participants, including the youngest group, reported they were exhausted. Their principal source of dissatisfaction was their impression that they could not do their work correctly. Participants reported that these difficulties required them to improvise and adapt without any official or formal method to keep their practice manageable.</p><p><strong>Conclusion: </strong>These GPs were worried about the future of their profession and their patients. They expected strong measures by public policymakers and officials, but paradoxically seemed to have little interest in the solutions these officials are promoting.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"1039-1047"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140193577","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 integrated care with case management and nutritional counselling for frail older adults with nutritional risk in the primary care setting.","authors":"Mei-Lan Hsiao, Chen-Ying Su, Ching-Hui Loh, Sheng-Lun Kao","doi":"10.1093/fampra/cmae011","DOIUrl":"10.1093/fampra/cmae011","url":null,"abstract":"<p><strong>Background: </strong>The effects of integrated care with case management and nutritional counselling for frail patients with nutritional risk are unclear.</p><p><strong>Objectives: </strong>To assess the impact of the integrated care model for frail patients with nutritional risk in the primary care setting.</p><p><strong>Methods: </strong>This was a retrospective observational study. We enrolled 100 prefrail or frail patients according to Clinical Frailty Scale (CFS) aged ≥ 60 years with nutritional risk from the geriatric clinic. We implemented the frailty intervention model, including integrated care with comprehensive geriatric assessments (CGA), case management, and nutritional counselling by the dietitian. We obtained measures of CGA components, physical performance, body mass index (BMI), and daily caloric intake before and after the 2-month care program. We used the Wilcoxon signed-rank test to analyse differences after the care program and applied multiple linear regression to determine the predictive factors for CFS improvement.</p><p><strong>Results: </strong>Among the 100 patients (mean age, 75.0 ± 7.2 years; females, 71.0%; frail patients, 26%), 93% improved their CFS status, and 91% achieved > 80% of recommended daily caloric intake after the care program. The Mini Nutritional Assessment Short-Form significantly improved after the program. BMI and daily caloric intake increased significantly after nutritional counselling. The post-test short physical performance battery (SPPB) significantly increased with a faster 4 m gait speed. Baseline poor CFS was a significant predictor for CFS improvement.</p><p><strong>Conclusions: </strong>Integrated care with case management and nutritional counselling for prefrail and frail patients with nutritional risk in the primary care setting may improve physical performance and nutritional status.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"1010-1017"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139995974","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":"Caring for patients with chronic illness: is respecting patient autonomy enough or must we promote patient autonomy as well?","authors":"Mark D Sullivan","doi":"10.1093/fampra/cmad066","DOIUrl":"10.1093/fampra/cmad066","url":null,"abstract":"","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"863-866"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9698526","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 effects of pregnancy-related changes in eating attitudes and behaviours on nutritional status.","authors":"Şule Aktaç, Hatice İkiışık, Güleren Sabuncular, Hayrunisa İçen, Fatma Esra Güneş","doi":"10.1093/fampra/cmae026","DOIUrl":"10.1093/fampra/cmae026","url":null,"abstract":"<p><strong>Background: </strong>During pregnancy, the requirements of essential nutrients for the mother and foetus increase. The changes in pregnant women's eating behaviours may vary according to their sociodemographic characteristics. It is important to meet these increased requirements and understand the factors influencing eating habits during pregnancy.</p><p><strong>Objectives: </strong>This study aimed to determine the effects of changes in pregnant women's eating attitudes and behaviours and their sociodemographic characteristics on their meeting status for nutrient recommendations.</p><p><strong>Methods: </strong>Sociodemographic information, eating behaviours, and attitudes of 656 pregnant women were obtained in face-to-face interviews between February and June 2020. Food consumption records were taken with a 24-hour recall method and evaluated according to the estimated average requirement value.</p><p><strong>Results: </strong>The average age of pregnant women was 29.0 ± 5.2 years, 28.0% were high school graduates, and 69.2% were non-working. The frequency of intakes below the estimated mean requirement value were iron, folic acid, vitamin B6, niacin, and calcium. It was demonstrated that there was a significant difference in snack consumption based on the working status and nutrition information obtained (P < .05). Getting nutrition information, age, education level, working status, and pre-pregnancy body mass index significantly increased food consumption (P < .05).</p><p><strong>Conclusion: </strong>Inadequate nutrient intake is a common public health problem in pregnant women. It is necessary to identify the sociodemographic characteristics that negatively impact pregnant women's nutritional status and to develop nutrition and health education programs based on these features.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"985-994"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904329","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":"Primary care physicians' work conditions and their confidence in managing multimorbidity: a quantitative analysis using Job Demands-Resources Model.","authors":"Ruixue Zhao, Jinnan Zhang, Mengyao Li, Ekaterina Loban, Stephen Nicolas, Elizabeth Martiland, Wenhua Wang","doi":"10.1093/fampra/cmad099","DOIUrl":"10.1093/fampra/cmad099","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity is a global issue that presents complex challenges for physicians, patients, and health systems. However, there is a lack of research on the factors that influence physicians' confidence in managing multimorbidity within primary care settings, particularly regarding physicians' work conditions.</p><p><strong>Objectives: </strong>Drawing on the Job Demands-Resources Model, this study aims to investigate the level of confidence among Chinese primary care physicians in managing multimorbidity and examine the predictors related to their confidence.</p><p><strong>Methods: </strong>Data were collected from 224 physicians working in 38 Community Healthcare Centres (CHCs) in Shanghai, Shenzhen, Tianjin, and Jinan, China. Work-family conflict (WFC) perceived organizational support (POS), self-directed learning (SDL), and burnout were measured. Physicians' confidence was assessed using a single item. Mediation effect analysis was conducted using the Baron and Kenny method.</p><p><strong>Results: </strong>The results showed that the mean confidence score for physicians managing multimorbidity was 3.63 out of 5, only 20.10% rating their confidence level as 5. WFC negatively related physicians' confidence and POS positively related physicians' confidence in multimorbid diagnosis and treatment. Burnout fully mediated the relationship between WFC and physicians' confidence, and SDL partially mediated the relationship between POS and physicians' confidence.</p><p><strong>Conclusions: </strong>The confidence level of Chinese primary care physicians in managing multimorbidity needs improvement. To enhance physicians' confidence in managing multimorbid patients, CHCs in China should address WFC and burnout and promote POS and SDL.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"977-984"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49676039","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":"Strengthening the Philippine Health Information System for future health crisis.","authors":"Dalmacito A Cordero","doi":"10.1093/fampra/cmad111","DOIUrl":"10.1093/fampra/cmad111","url":null,"abstract":"","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"867-868"},"PeriodicalIF":2.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138444414","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}