Family practice最新文献

{"title":"The presentation and treatment of Dupuytren's disease in Dutch general practitioner care.","authors":"Roel J M van Straalen, Dieuwke C Broekstra, Paul M N Werker, Michiel R de Boer","doi":"10.1093/fampra/cmae065","DOIUrl":"10.1093/fampra/cmae065","url":null,"abstract":"<p><strong>Background: </strong>When research and management of Dupuytren's disease (DD) shift from symptom relief to preventing contractures, general practitioner (GP) care may become more central to treatment. However, the presentation and course of DD in GP care are underexplored and this has been recognized as a knowledge gap that hinders effective treatment decisions. This study is the first to map the trajectory of DD patients in GP care.</p><p><strong>Methods: </strong>Using electronic health records from Dutch general practices in a regional research network, we conducted a registration-based cohort study in a dynamic population. Descriptive statistics detailed patient demographics, number of contacts, and symptoms per contact. The time and number of contacts before diagnosis were also analysed. Sankey diagrams illustrated the relationship between management options and symptoms.</p><p><strong>Results: </strong>Over a 16-year period, 84% of patients with a DD diagnosis had visited their GP for this reason, with 73% only having one GP contact. The diagnosis was made at first contact for 93% of patients. Initial contacts often reported a lump (57.3%), but this symptom was less frequent in subsequent visits. 'Daily life impairment' increased after the first contact. The most common management options were referral to secondary care (37.7%) and watchful waiting (35.1%).</p><p><strong>Conclusion: </strong>The diagnosis and management of DD in GP care are in line with the current guidelines. Less than half of the DD patients were referred to secondary care during follow-up. This may give room for preventive treatment that limits progression. Future studies should focus on the accuracy of diagnosis and the feasibility of effective treatments in GP care.</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/PMC11811527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681095","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":"Defining quality categories for evaluation of the doctor-patient relationship assessed through the patient-doctor relationship questionnaire (PDRQ-9).","authors":"Lucas Wollmann, Lisiane Hauser, Christina van der Feltz-Cornelis, Sotero Serrate Mengue, Rudi Roman, Milena Rodrigues Agostinho Rech, Erno Harzheim","doi":"10.1093/fampra/cmae068","DOIUrl":"10.1093/fampra/cmae068","url":null,"abstract":"<p><strong>Background: </strong>The quality of the doctor-patient relationship plays a crucial role in patients' experiences with healthcare services, positively influencing clinical outcomes and satisfaction with care. The Patient-Doctor Relationship Questionnaire (PDRQ-9) is widely used to assess this relationship. However, there are no quality categories that can be derived from the instrument's score to facilitate understanding and decision-making.</p><p><strong>Objectives: </strong>This study aims to establish categories of the quality of the relationship based on the PDRQ-9 score.</p><p><strong>Methods: </strong>A latent class analysis (LCA) was conducted using interviews with 6160 users of primary health care units throughout Brazil to define different homogeneous response profiles. The Youden index was used to determine the cut point between classes.</p><p><strong>Results: </strong>LCA identified the presence of two response profiles, one associated with a high evaluation of the quality of the doctor-patient relationship and another associated with a moderate evaluation. The cut point between classes, established through the Youden index, was 3.5 (on a possible score range of 1-5) or 31 (on a possible score range of 9-45). The cut point demonstrated high accuracy (0.94), sensitivity (0.96), and specificity (0.98).</p><p><strong>Conclusions: </strong>The categorization proposed in this study enhances the interpretability of PDRQ-9 results, providing a practical framework for assessing the quality of the doctor-patient relationship. By establishing actionable quality categories, this tool could support targeted interventions, such as performance feedback and training, aimed at fostering empathy, communication, and trust in healthcare settings.</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":"142738906","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":"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":"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}

{"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":"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":"Provider experiences delivering collaborative care for co-occurring opioid and mental health disorders: a qualitative study.","authors":"Jasen Christensen, Grace Hindmarch, Lizeth Cueto, Maya Rabinowitz, Valerie Carrejo, Scott Jeansonne, John Bettler, Seth Williams, Miriam Komaromy, Katherine Watkins, Karen Chan Osilla","doi":"10.1093/fampra/cmaf007","DOIUrl":"10.1093/fampra/cmaf007","url":null,"abstract":"<p><strong>Background: </strong>Opioids are the primary contributor to overdose death in the USA and represent a major public health crisis despite the availability of highly effective evidence-based treatments. A co-occurring mental health disorder further complicates efforts to utilize effective treatments and leads to poorer outcomes. Collaborative care has shown promise in improving care for those with substance use disorders and those with mental health disorders. This study explores the experiences of providers participating in a randomized controlled trial of collaborative care for both opioid use disorder (OUD) and co-occurring depression and/or posttraumatic stress disorder (COD).</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with healthcare providers of collaborative care as part of a randomized controlled trial at two health systems. Interviewed participants included primary care providers, care coordinators, behavioral health providers, clinic administrators, and psychiatric consultants. Data was analyzed with content analysis to identify common themes and subthemes among experiences.</p><p><strong>Findings: </strong>Participants perceived differences between patients diagnosed with only OUD and those with COD, such as heightened stigma, greater symptom severity, and more barriers to treatment. They perceived the positive impacts of the collaborative care intervention for patients with COD and the clinics and providers caring for this population, and identified considerations for future implementation efforts.</p><p><strong>Conclusions: </strong>Although participants noted challenges in treating patients with COD compared to those with only OUD, they also perceived the benefits of using collaborative care in this complex population. Participants supported using collaborative care in the future, but noted important systems and policy suggestions needed for successful implementation.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656433","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":"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}