Family practice最新文献

{"title":"The challenges experienced by Ukrainian refugees accessing General Practice: a descriptive cross-sectional study.","authors":"Niall O'Reilly, Emmet Smithwick, Eoin Murphy, Aisling A Jennings","doi":"10.1093/fampra/cmaf012","DOIUrl":"10.1093/fampra/cmaf012","url":null,"abstract":"<p><strong>Background: </strong>The war in Ukraine has led to an influx of Ukrainian refugees across Europe. Internationally, there is limited research into refugees' experiences of accessing Primary Care. Furthermore, few studies have explored the experience of one homogenous refugee group. No study has explored the specific experience of Ukrainian refugees. To improve the care provided to this marginalized group it is important to understand the challenges they experience. The aim of this research is to identify the barriers Ukrainian refugees experience when accessing General Practice in Ireland.</p><p><strong>Methods: </strong>A 63-item questionnaire was distributed via Ukraine Action Ireland, a registered charitable organization, to Ukrainian refugees in Ireland. Qualitive comments were collected through free-text responses and were analysed using thematic analysis.</p><p><strong>Results: </strong>A total of 368 questionnaires were completed. About 75.4% of respondents reported that they were not asked about their mental health during consultations with their GP. About 25% of respondents could not attend GP due to transport difficulties. About 55% of respondents reported that a translator was needed but only one-third of respondents reported that one was offered. Self-reported health was relatively poor when compared with refugees in other countries and with Irish citizens. Three themes were developed; disparity in patient autonomy, perceived disregard for the refugee experience, and challenges in health care access.</p><p><strong>Conclusion: </strong>At a time of significant capacity challenges in General Practice it is paramount that resources are provided at a national level to address the challenges Ukrainian refuges currently experience.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656363","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":"Patients' experience of integrated nursing care in general practices in Switzerland: a mixed-methods study.","authors":"Muriel Schütz Leuthold, Fatima El Hakmaoui, Renzo Scuderi, Nicolas Senn, Christine Cohidon","doi":"10.1093/fampra/cmaf011","DOIUrl":"10.1093/fampra/cmaf011","url":null,"abstract":"<p><strong>Background: </strong>In many high-income countries, nurses, including registered nurses (RNs), play a key role in primary care (PC), particularly in general practice. Their involvement enhances patients' experiences, especially in terms of accessibility and comprehensiveness of care provided. To reinforce the provision of care and enhance patients' experience in family medicine, RNs were integrated into eight private general practices in the canton of Vaud, Switzerland, creating interprofessional teams. This study assessed patients' experiences with new nursing activities in general practices.</p><p><strong>Methods: </strong>A mixed-methods approach was used to assess patients' experiences. Quantitative data were collected through a patient experience survey conducted before and after nursing follow-up, with descriptive and bivariate analyses performed. Qualitative data were obtained from interviews with ten patients.</p><p><strong>Results: </strong>A total of 109 patients completed the questionnaire before and after nursing follow-up. Descriptive analyses showed that several dimensions of patients' experience improved with new nursing follow-up. Bivariate analyses revealed significant improvements in several areas, including unmet healthcare needs, accessibility to nursing care, preventive care, and information provided. Furthermore, patients reported positive changes in their health and lifestyle due to preventive care. Qualitative data supported these results, highlighting the importance of nurses' accessibility and availability and the holistic nursing care provided.</p><p><strong>Conclusion: </strong>These findings highlight the potential of nurse-led case management to address gaps in PC delivery, particularly in managing chronic diseases. The integration of nurses into general practice settings improved the provision of preventive care, enhanced patient education, and increased accessibility to care.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656429","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":"Point-of-care ultrasound to assess left ventricular ejection fraction in heart failure in unselected patients in primary care: a systematic review.","authors":"Perrine Allimant, Lucas Guillo, Thomas Fierling, Andry Rabiaza, Isabelle Cibois-Honnorat","doi":"10.1093/fampra/cmae040","DOIUrl":"10.1093/fampra/cmae040","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is the most frequent cardiovascular pathology in primary care. Echocardiography is the gold standard for diagnosis, follow-up, and prognosis of HF. Point-of-care ultrasound (POCUS) is of growing interest in daily practice.</p><p><strong>Aim: </strong>This study aimed to systematically review the literature to evaluate left ventricular ejection fraction (LVEF) assessment of unselected patients in primary care by non-expert physicians with cardiac POCUS (cPOCUS).</p><p><strong>Methods: </strong>We searched in Medline, Embase, and Pubmed up to January 2024 for interventional and non-interventional studies assessing LVEF with cPOCUS in unselected patients with suspected or diagnosed HF in hospital or outpatient settings, performed by non-expert physicians.</p><p><strong>Results: </strong>Forty-two studies were included, involving 6598 patients, of whom 60.2% were outpatients. LVEF was assessed by 351 non-expert physicians after an initial ultrasound training course. The LVEF was mainly assessed by visual estimation (90.2%). The most frequent views were parasternal long/short axis, and apical 4-chamber. The median time of cPOCUS was 8 minutes. A strong agreement was found (κ = 0.72 [0.63; 0.83]) compared to experts when using different types of ultrasound devices (hand-held and standard), and agreement was excellent (κ = 0.84 [0.71; 0.89]) with the same device. Training course combined a median of 4.5 hours for theory and 25 cPOCUS for practice.</p><p><strong>Conclusion: </strong>The use of cPOCUS by non-expert physicians after a short training course appears to be an accurate complementary tool for LVEF assessment in daily practice. Its diffusion in primary care could optimize patient management, without replacing specialist assessment.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003992","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":"Telemedicine and time management in primary care.","authors":"Yael Keshet, Ariela Popper-Giveon, Tamar Adar","doi":"10.1093/fampra/cmae051","DOIUrl":"10.1093/fampra/cmae051","url":null,"abstract":"<p><strong>Background: </strong>Information and communication technologies (ICTs) can enable workers to structure work in novel ways, allow for better time management, and increase work scheduling autonomy. Time management and work scheduling are important factors in the field of clinical practice in primary care. Time limits on consultation are a key constraint on the delivery of good care since the length of patient-physician consultation impacts its quality.</p><p><strong>Objectives: </strong>This research aimed to examine the experiences of primary care physicians (PCPs) when using telemedicine technologies (TTs), a type of ICT, in their communication with patients.</p><p><strong>Methods: </strong>During 2023 in-depth interviews were conducted with 20 Israeli PCPs: family physicians and pediatricians.</p><p><strong>Findings: </strong>Perception and management of time emerged as a focal subject in the interviews. The PCPs interviewed described several effects of TTs on time management in primary care. They portrayed TTs as saving time for patients and having a mixed effect on the healthcare organization: both saving and wasting their work time. TTs were described as impacting their time management in the context of work-life balance, allowing them to manage their time during and between appointments.</p><p><strong>Discussion: </strong>For PCPs, TTs can be beneficial for managing time in the clinic, which can contribute to better healthcare. This article, concerning TTs as a type of ICT, contributes to the existing literature which suggests that ICTs can allow for better time management and increase work scheduling autonomy. It also presents several recommendations for better implementation of TTs in healthcare organizations.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461447","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":"Expanding the primary care workforce by integrating genetic counselors in multidisciplinary care teams.","authors":"Rachel Vanneste, Sasha A Bauer, Kennedy Borle, Erika Dreikorn","doi":"10.1093/fampra/cmae057","DOIUrl":"10.1093/fampra/cmae057","url":null,"abstract":"<p><p>Collectively, rare diseases are common, affecting approximately 8% of the population in Canada and the USA. Therefore, the majority of primary care (PC) clinicians will care for patients who are affected or at risk for a genetic disease. Considering the increasing ways in which genetics is being implemented into all areas of healthcare, one way to address these needs and expand the capacity of the PC workforce is through the integration of genetic counselors (GCs) into PC multidisciplinary teams. GCs are Masters-educated allied health professionals with specialized training in molecular genetics, communication, and short-term psychotherapeutic counseling. The current models of GCs in PC mimic other multidisciplinary models. Complex tasks related to genetics, such as pre- and post-test counseling, genetic test selection, and results interpretation, are conducted by GCs, which, in turn, allows physicians, nurse practitioners, and other PC providers to work at the top of their scope of practice. Quality genetics services provided by GCs improve clinical outcomes for patients and their families; the simultaneous provision of genetic education and psychological support by a GC is associated with an increase in patient knowledge, perceived personal control, decrease in distress, and can lead to positive health behavior changes, all of which are aligned with the goals of primary healthcare. With their extensive training in clinical care, medical communication, and psychotherapeutic counseling, integrating GCs into PC care teams will improve the care patients receive and allow PC clinicians to ensure their patients are at the forefront of the personalized medicine revolution.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497734","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":"Enhancing the role of general practitioner trainers in supporting antibiotic stewardship initiatives.","authors":"Waseem Jerjes","doi":"10.1093/fampra/cmae058","DOIUrl":"10.1093/fampra/cmae058","url":null,"abstract":"","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461444","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":"Are we ready? assessing effectiveness and implementation of cancer control strategies in primary care: a comprehensive review of systematic reviews.","authors":"Javiera Martinez-Gutierrez, María Gabriela Soto, Andrea Rioseco, Catalina Bienzobas, Madeline Fowler, Gonzalo Ulloa, Mauricio Soto, Jon David Emery, Klaus Puschel","doi":"10.1093/fampra/cmae078","DOIUrl":"10.1093/fampra/cmae078","url":null,"abstract":"<p><strong>Background: </strong>Cancer is a major global cause of death, and primary care is crucial for cancer prevention and early detection. However, there is conflicting information on the effectiveness, implementation, and sustainability of cancer control interventions in primary care.</p><p><strong>Objective: </strong>This study aimed to summarize the evidence for cancer control in primary care, focussing on identifying relevant factors for implementation and sustainability.</p><p><strong>Study setting and design: </strong>We conducted a narrative, mixed-methods review of systematic reviews, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Four databases were screened, and two independent reviewers selected studies reporting on cancer prevention, screening, or early detection in primary or community settings. We analysed findings using the extended Reach-Effectiveness-Adopt-Implementation-Maintenance (RE-AIM) Framework.</p><p><strong>Principal findings: </strong>From the 37 reviews that met the inclusion criteria, 6 focussed on primary prevention, 23 on screening, and 12 on early detection. Most reviews (78%) addressed intervention effectiveness, such as HPV vaccination, tobacco cessation, and cervical, breast, and colorectal screening. One-third of the reviews mentioned adoption and implementation factors, including barriers and facilitators to the implementation of cancer screening programs. Only one review addressed maintenance and sustainability factors, exploring continuous resources and funding strategies.</p><p><strong>Conclusion: </strong>While numerous interventions are effective for cancer prevention and detection in primary care, literature on implementation and sustainability strategies is lacking. Focusing on continuous resources and funding for cancer strategies in primary care may aid sustainability. Future research should prioritize reporting on implementation and sustainability factors to enhance cancer prevention and control in primary care settings.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364177","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":"Correction to: A 2-item version of the Japanese Consultation and Relational Empathy measure: a pilot study using secondary analysis of a cross-sectional survey in primary care.","authors":"","doi":"10.1093/fampra/cmae060","DOIUrl":"10.1093/fampra/cmae060","url":null,"abstract":"","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568287","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":"Variation in general practitioners' follow-up of depressed patients starting antidepressant medication: a register-based cohort study.","authors":"Anneli B Hansen, Øystein Hetlevik, Valborg Baste, Inger Haukenes, Tone Smith-Sivertsen, Sabine Ruths","doi":"10.1093/fampra/cmae063","DOIUrl":"10.1093/fampra/cmae063","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend follow-up within 2 weeks for patients starting medication for depression. Knowledge is lacking about how general practitioners' (GPs) follow-up varies with patients' sociodemographic characteristics.</p><p><strong>Objective: </strong>To describe follow-up by GP and specialist in mental healthcare provided to men and women with depression within 3 months of starting drug therapy. Furthermore, to examine whether follow-up varied according to patients' age and education.</p><p><strong>Methods: </strong>Registry-based cohort study comprising all patients aged ≥18 years in Norway with a new depression episode in 2014 who started on antidepressants within 12 months from diagnosis. Patients' age and educational level were the exposures. Outcomes were follow-up by GP and/or mental healthcare specialist, and talking therapy with GP, within 90 days of first prescription. Cox proportional hazard models were used to estimate the likelihood of having follow-up contacts. Log binomial regression analysis was performed to explore the likelihood of having talking therapy with a GP. Time to first contact was illustrated by Kaplan-Meier survival curves.</p><p><strong>Results: </strong>The study population comprised 17 000 patients, mean age 45.7 years, 60.6% women. Only 27.8% of the patients were followed up by GP and/or specialist within 2 weeks of the first drug dispensing, 67.1% within 90 days. Older or less educated men and women received less and later contacts than the younger or more highly educated.</p><p><strong>Conclusions: </strong>Differences in age and educational level were associated with follow-up of depressed patients who started medication. This may indicate unwarranted variation in depression care that GPs should consider when prescribing antidepressants.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681020","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":"Case control study of access to medications during COVID-19 and primary care patients managing multiple chronic conditions.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1093/fampra/cmaf004","DOIUrl":"https://doi.org/10.1093/fampra/cmaf004","url":null,"abstract":"","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656414","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}