Family practice最新文献

{"title":"Developing a urinary incontinence primary care pathway: a mixed methods study.","authors":"Marie C Luebke, Joan M Neuner, Joanna Balza, Emily R W Davidson, James A Hokanson, Sarah Marowski, Robert Corey O'Connor, Emily Schmitt, Aaron N Winn, Kathryn E Flynn","doi":"10.1093/fampra/cmae035","DOIUrl":"10.1093/fampra/cmae035","url":null,"abstract":"<p><strong>Background: </strong>While nearly 50% of adult women report at least one episode of urinary incontinence (UI), most never receive treatment.</p><p><strong>Objective: </strong>To better integrate primary and specialty UI care, we conducted (i) an environmental scan to assess the availability of key pathway resources in primary care, (ii) interviews with primary care providers to understand barriers to care, and (iii) a pilot UI care pathway intervention.</p><p><strong>Methods: </strong>Environmental scan: Clinic managers from all primary care clinics within a Midwestern healthcare system were invited to participate in an interview covering the availability of clinic resources. Provider interviews: Primary care providers were invited to participate in an interview covering current practices and perceived barriers to UI care. Pilot UI care pathway: Patients who screened positive for UI were provided resources for first-line behavioral management. Pilot patients completed questionnaires at baseline, 8 weeks, and 6 months.</p><p><strong>Results: </strong>While many clinics had point-of-care urinalysis (17/21, 81%), most did not have a working bladder ultrasound (14/21, 67%) or on-site pelvic floor physical therapy (18/21, 86%). Providers (n = 5) described barriers to completing almost every step of diagnosis and treatment for UI. The most persistent barrier was lack of time. Patients (n = 15) reported several self-treatment strategies including avoiding bladder irritants (7/15, 47%) and performing Kegel exercises (4/15, 27%). Five patients (33%) requested follow-up care. At 6 months, patients reported small improvements in UI symptoms.</p><p><strong>Conclusion: </strong>Promising results from a novel UI care pathway pilot indicate that streamlining UI care may assist primary care providers in the first-line treatment of UI.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"798-806"},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723326","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":"Screening for primary aldosteronism in primary care: a scoping review.","authors":"Kirsten Tsan, Jun Yang, Abhir Nainani, Renata Libianto, Grant Russell","doi":"10.1093/fampra/cmae033","DOIUrl":"10.1093/fampra/cmae033","url":null,"abstract":"<p><strong>Background: </strong>Primary aldosteronism (PA) is the most common treatable and potentially curable cause of secondary hypertension. Prompt diagnosis and management by primary care physicians (PCPs) is important given the increased risk of cardiovascular complications however screening rates are low in primary care. Our aim was to identify factors that influence screening behaviour for PA among PCPs.</p><p><strong>Method: </strong>A rigorous scoping review of seven databases between 16/08/22 and 09/08/23 was used to investigate PA screening practices. Articles written in English from peer-reviewed literature within the last 20 years were eligible for inclusion if an aspect of their study was conducted in primary care.</p><p><strong>Results: </strong>A total of 1380 titles and abstracts, and 61 full texts were screened, with 20 studies selected for data extraction. We identified three broad categories of factors influencing screening by PCPs-the patient, the clinician, and the healthcare system. Some studies targeted these factors to improve screening rates although there is little data on implementation and outcomes.</p><p><strong>Conclusion: </strong>Low awareness, inadequate guidelines, and poor access to testing were identified as key barriers to PA screening. Targeted education sessions for PCPs, clear guidelines, and closer proximity to diagnostic centres may be required to improve PA detection in primary care.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"851-856"},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442399","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":"Association of neighbourhood walkability and haemoglobin A1c levels among Latino and non-Hispanic White patients with diabetes.","authors":"Jennifer A Lucas, Miguel Marino, Sophia Giebultowicz, Dang Dinh, Roopradha Datta, David Boston, John Heintzman","doi":"10.1093/fampra/cmae018","DOIUrl":"10.1093/fampra/cmae018","url":null,"abstract":"<p><strong>Background: </strong>Neighbourhood walkability can benefit cardiovascular health. Latino patients are more likely than non-Hispanic White patients to have diabetes, and evidence has shown better diabetes-related outcomes for patients living in neighbourhoods conducive to physical activity. Our objective was to determine whether neighbourhood walkability was associated with haemoglobin A1c (HbA1c) levels among English- and Spanish-preferring Latino patients compared to non-Hispanic White patients.</p><p><strong>Methods: </strong>We used electronic health record data from patients in the OCHIN, Inc. network of community health centres (CHC) linked to public walkability data. Patients included those age ≥ 18 with ≥ 1 address recorded, with a study clinic visit from 2012 to 2020, and a type 2 diabetes diagnosis (N = 159,289). Generalized estimating equations logistic regression, adjusted for relevant covariates, was used to model the primary binary outcome of always having HbA1c < 7 by language/ethnicity and walkability score.</p><p><strong>Results: </strong>For all groups, the walkability score was not associated with higher odds and prevalence of always having HbA1c < 7. Non-Hispanic White patients were most likely to have HbA1c always < 7 (prevalence ranged from 32.8% [95%CI = 31.2-34.1] in the least walkable neighbourhoods to 33.4% [95% CI 34.4-34.7] in the most walkable), followed by English-preferring Latinos (28.6% [95%CI = 25.4-31.8]-30.7% [95% CI 29.0-32.3]) and Spanish-preferring Latinos (28.3% [95% CI 26.1-30.4]-29.3% [95% CI 28.2-30.3]).</p><p><strong>Conclusions: </strong>While walkability score was not significantly associated with glycaemic control, control appeared to increase with walkability, suggesting other built environment factors, and their interaction with walkability and clinical care, may play key roles. Latino patients had a lower likelihood of HbA1c always < 7, demonstrating an opportunity for equity improvements in diabetes care.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"719-725"},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287264","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":"Who are the patients who use non-pharmacological home remedies? Cross-sectional study in Switzerland and France.","authors":"Paul Sebo, Neria E Winkler, Marie Morel, Mohamed Amir Moussa, Dagmar M Haller, Hubert Maisonneuve","doi":"10.1093/fampra/cmae030","DOIUrl":"10.1093/fampra/cmae030","url":null,"abstract":"<p><strong>Background: </strong>Many patients may be tempted to use non-pharmacological home remedies (NPHRs) to relieve various complaints. To the best of our knowledge, there is little data on the characteristics of patients using NPHRs. In this cross-sectional study carried out between March 2020 and July 2021, we examined the socio-demographic factors underlying their use in patient populations in Switzerland and France.</p><p><strong>Methods: </strong>Using official registries, we randomly selected 50 primary care physicians (PCPs) in Geneva (Switzerland) and Lyon/Grenoble (France). Seven research assistants consecutively recruited patients from PCP waiting rooms (20-25 patients per practice). Patients completed a paper-based questionnaire assessing the use [yes/no] of 304 NPHRs for 79 medical conditions. The NPHR list was developed by our team with input from 97 patients. We used univariable and multivariable logistic regressions, adjusting for intra-cluster correlations, to examine associations between NPHR use and patient characteristics (gender, age, practice location, nationality, education level, and self-rated health).</p><p><strong>Results: </strong>Of the 1198 eligible patients, 1012 agreed to participate (85%). Overall, 635 patients (63%) reported using at least one of the remedies tested in the study. In multivariable analysis, women (OR = 1.7 [95%CI = 1.3-2.3], P-value < 0.001), younger patients (< 40 years: OR = 2.1 [95%CI = 1.6-2.9], P-value < 0.001), and French patients (OR = 1.6 [95%CI = 1.1-2.3], P-value < 0.001) tended to use NPHRs more often than other patients.</p><p><strong>Conclusions: </strong>Many patients, particularly women, young people, and French patients, reported using NPHRs. This survey's findings hold the potential to inform healthcare providers, policymakers, and researchers about the diverse preferences that shape patients' healthcare choices.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"841-845"},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155050","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":"Epidemiology and clinical correlates of hidradenitis suppurativa in primary care in Italy.","authors":"Francesco Lapi, Ettore Marconi, Lucia Casoli, Andrea Tedeschi, Barbara Giomi, Claudio Cricelli","doi":"10.1093/fampra/cmae037","DOIUrl":"10.1093/fampra/cmae037","url":null,"abstract":"<p><strong>Background: </strong>Hidradenitis suppurativa (HS) is a persistent skin disorder that is characterized by painful lesions or pus-filled lumps, mostly occurring in areas where the skin flexes. It is a disfiguring condition that significantly reduces the quality of life of those affected. Developing new, effective treatments for HS is crucial, but it is important that it be recognized and diagnosed early, especially in primary care settings.</p><p><strong>Objectives: </strong>To assess the epidemiology and clinical correlates of HS in a primary care setting. The study utilized the Italian Health Search Database (HSD). A case-control design was adopted to investigate the clinical correlates of HS. Cases were classified as either \"definite\" or \"probable\" using an operational algorithm. Up to 10 controls were matched to each case based on factors such as calendar period, age, sex, and duration of follow-up.</p><p><strong>Results: </strong>Cumulative prevalence of HS increased from 0.06% in 2002 to 0.46% in 2021. When only \"definite\" cases were considered, the prevalence was almost 10 times lower (0%-0.02%). Several clinical correlates were found to be positively associated with HS, including obesity, dyslipidemia, hypertension, autoimmune/inflammatory diseases, and depression.</p><p><strong>Conclusions: </strong>This study found that correct diagnoses of HS were made, as demonstrated by the expected relationship with clinical correlates. These associations were consistent when probable cases were included in the analysis. This evidence could serve as a foundation for proposing a decision support system for general practitioners to help identify HS in individuals with certain coexisting conditions.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"711-718"},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055224","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":"A study of patients' choice of medical treatment based on rational choice theory: a cross-sectional survey from China.","authors":"Jin Li, Ning Zhao, Mei Gu, Danhui Li, Jia Yang","doi":"10.1093/fampra/cmae039","DOIUrl":"10.1093/fampra/cmae039","url":null,"abstract":"<p><strong>Objective: </strong>To describe how patients choose between primary care institutions (PCIs) and non-PCIs using rational choice theory from the perspective of survival rationality, economic rationality, and social rationality.</p><p><strong>Methods: </strong>Multi-stage stratified sampling and convenience sampling were applied to select 1723 patients to conduct the questionnaire survey. Chi-square test and binary logistic regression were performed to analyze the factors associated with patients' choice of PCIs.</p><p><strong>Results: </strong>In total 55.83% of 1723 patients would attend a PCIs for healthcare. The results of the univariate analysis revealed that patients who are female (58.46%, P = .015), suffering from chronic diseases (56.26%, P = .047), inpatients (67.58%, P < .001), Beijing (59.62%, P = .002), partial understanding of the family doctor contracting system (62.30%, P < .001), and not understanding of the medical alliance policy (58.04%, P = .031) had significantly higher probability of choosing PCIs. Logistic regression analysis showed that females were more unwilling to attend PCIs (odds ratio (OR) = 0.822, 95%CI: 0.676-0.999). Following survival rationality, patients without chronic diseases were more likely to attend PCIs (OR = 1.834, 95%CI: 1.029-3.268), and inpatients were more unlikely to attend PCIs (OR = 0.581, 95%CI: 0.437-0.774). From an economic rationality perspective, patients from the Fujian province were more likely to attend PCIs (OR = 1.424, 95%CI: 1.081-1.876). From a social rationality perspective, patients who partial understanding of the family doctor contracting system were more unlikely to attend PCIs (OR = 0.701, 95%CI: 0.551-0.892), and patients who partial and complete understanding of the medical alliance policy were more likely to attend PCIs (OR = 1.340, 95%CI: 1.064-1.687; OR = 1.485, 95%CI: 1.086-2.030).</p><p><strong>Conclusions: </strong>Survival, economic, and social rationality are involved in patients' choice to attend PCIs. Compared to survival rationality and social rationality, economic rationality showed a lower association with patients' choice to attend PCIs. Medical institutions are recommended to adopt a \"patient health-centered\" approach when providing medical services and further optimize the family doctor contracting system and construction of medical alliances.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"745-754"},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003991","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":"Topical or oral antibiotics in childhood acute otitis media and ear discharge: a randomized controlled non-inferiority trial.","authors":"Saskia Hullegie, Roger A M J Damoiseaux, Alastair D Hay, Nicolaas P A Zuithoff, Thijs M A van Dongen, Paul Little, Anne G M Schilder, Roderick P Venekamp","doi":"10.1093/fampra/cmae034","DOIUrl":"10.1093/fampra/cmae034","url":null,"abstract":"<p><strong>Background: </strong>Current guidance suggests oral antibiotics can be considered for children with acute otitis media (AOM) and ear discharge, but there is an absence of evidence regarding the relative effectiveness of antibiotic-corticosteroid eardrops.</p><p><strong>Aim: </strong>To establish whether antibiotic-corticosteroid eardrops are non-inferior to oral antibiotics in children with AOM and ear discharge.</p><p><strong>Design and setting: </strong>Open randomized controlled non-inferiority trial set in Dutch primary care.</p><p><strong>Methods: </strong>Children were randomized to hydrocortisone-bacitracin-colistin eardrops (five drops, three times per day in the discharging ear(s)) or amoxicillin suspension (50 mg per kilogram of body weight per day, divided over three doses administered orally) for 7 days. The primary outcome was the proportion of children with resolution of ear pain and fever at day 3.</p><p><strong>Results: </strong>Between December 2017 and March 2023, 58 of the planned 350 children were recruited due to slow accrual for various reasons. Children assigned to eardrops (n = 26) had lower resolution rates of ear pain and fever at 3 days compared to those receiving oral antibiotics (n = 31): 42% vs 65%; adjusted risk difference 20.3%, 95% confidence interval -5.3% to 41.9%), longer parent-reported ear discharge (6 vs 3 days; P = .04), and slightly higher mean ear pain scores (Likert scale 0-6) over days 1-3 (2.1 vs 1.4, P = .02), but received fewer oral antibiotic courses in 3months (11 for 25 children vs 33 for 30 children), and had less GI upset and rash (12% vs 32% and 8% vs 16%, respectively).</p><p><strong>Conclusion: </strong>Early termination stopped us from determining non-inferiority of antibiotic-corticosteroid eardrops. Our limited data, requiring confirmation, suggest that oral antibiotics may be more effective than antibiotic-corticosteroid eardrops in resolving symptoms and shortening the duration of ear discharge.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"857-861"},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442400","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":"The role of primary care attributes in preventing loss or change of usual source of care: a nationwide cohort study.","authors":"Takuya Aoki, Sota Zukeran, Masato Matsushima","doi":"10.1093/fampra/cmae006","DOIUrl":"10.1093/fampra/cmae006","url":null,"abstract":"<p><strong>Background: </strong>The existence of a stable usual source of care (USC) is fundamental to the provision of quality health care. However, no longitudinal studies have examined whether core primary care attributes influence the stability of USC status.</p><p><strong>Objectives: </strong>We aimed to examine the association between primary care attributes (first contact, longitudinality, coordination, comprehensiveness, and community orientation) and the loss or change of USC.</p><p><strong>Methods: </strong>This nationwide cohort study was conducted during the coronavirus disease 2019 pandemic using a representative sample of the Japanese adult population aged 40-75 years. The primary outcome measures were loss of USC and voluntary change in USC during the 12-month follow-up period. Primary care attributes were evaluated in the baseline survey using the Japanese version of Primary Care Assessment Tool (JPCAT).</p><p><strong>Results: </strong>Data were analyzed for 725 participants who had a USC at baseline. Among them, 93 (12.8 %) lost their USC and 46 (6.3%) changed their USC during the follow-up period. Multivariable multinominal logistic regression analyses showed that the JPCAT total score was associated with decreased loss of USC and change in USC. Among the JPCAT domains, longitudinality, comprehensiveness (services available), and community orientation were associated with reductions in both USC loss and change.</p><p><strong>Conclusions: </strong>Our study indicates that primary care attributes play an important role in preventing the loss or change of USC and contribute to the stability of USC status. These findings provide additional rationale for policymakers, healthcare providers, and managers to seek to strengthen core attributes of primary care.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"726-731"},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930744","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":"Telephone triage of chest pain in out-of-hours primary care: external validation of a symptom-based prediction rule to rule out acute coronary syndromes.","authors":"Amy Manten, Ralf E Harskamp, Wim B Busschers, Eric P Moll van Charante, Jelle C L Himmelreich","doi":"10.1093/fampra/cmae028","DOIUrl":"10.1093/fampra/cmae028","url":null,"abstract":"<p><strong>Introduction: </strong>Telephone triage is pivotal for evaluating the urgency of patient care, and in the Netherlands, the Netherlands Triage Standard (NTS) demonstrates moderate discrimination for chest pain. To address this, the Safety First Prediction Rule (SFPR) was developed to improve the safety of ruling out acute coronary syndrome (ACS) during telephone triage.</p><p><strong>Methods: </strong>We conducted an external validation of the SFPR using data from the TRACE study, a retrospective cohort study in out-of-hours primary care. We evaluated the diagnostic accuracy assessment for ACS, major adverse cardiovascular events (MACE), and major events within 6 weeks. Moreover, we compared its performance with that of the NTS algorithm.</p><p><strong>Results: </strong>Among 1404 included patients (57.3% female, 6.8% ACS, 8.6% MACE), the SFPR demonstrated good discrimination for ACS (C-statistic: 0.79; 95%-CI: 0.75-0.83) and MACE (C-statistic: 0.79; 95%-CI: 0.0.76-0.82). Calibration was satisfactory, with overestimation observed in high-risk patients for ACS. The SFPR (risk threshold 2.5%) trended toward higher sensitivity (95.8% vs. 86.3%) and negative predictive value (99.3% vs. 97.6%) with a lower negative likelihood ratio (0.10 vs. 0.34) than the NTS algorithm.</p><p><strong>Conclusion: </strong>The SFPR proved robust for risk stratification in patients with acute chest pain seeking out-of-hours primary care in the Netherlands. Further prospective validation and implementation are warranted to refine and establish the rule's clinical utility.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"832-840"},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157917","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":"Identifying risk factors for developing obesity: a record linkage longitudinal study in metropolitan Sydney using the 45 and Up Study.","authors":"Kylie Vuong, Alamgir Kabir, Damian P Conway, Margaret Williamson, Mark F Harris, Margo L Barr","doi":"10.1093/fampra/cmae015","DOIUrl":"10.1093/fampra/cmae015","url":null,"abstract":"<p><strong>Background: </strong>Primary care clinicians have key responsibilities in obesity prevention and weight management.</p><p><strong>Aims: </strong>We aimed to identify risk factors for developing obesity among people aged ≥45 years.</p><p><strong>Methods: </strong>We conducted a record linkage longitudinal study of residents of metropolitan Sydney, Australia using data from the: (1) 45 and Up Study at baseline (2005-2009) and first follow-up (2012-2015); (2) Medicare claims; (3) Pharmaceutical Benefits Scheme; and (4) deaths registry. We examined risk factors for developing obesity (body mass index [BMI]: 30-40) at follow-up, separately for people within the: (1) healthy weight range (BMI 18.5-<25) and (2) overweight range (BMI 25-<30) at baseline. Covariates included demographics, modifiable behaviours, health status, allied health use, and medication use. Crude and adjusted relative risks were estimated using Poisson regression modelling.</p><p><strong>Results: </strong>At follow-up, 1.1% (180/16,205) of those in the healthy weight range group, and 12.7% (1,939/15,266) of those in the overweight range group developed obesity. In both groups, the following were associated with developing obesity: current smoking at baseline, physical functioning limitations, and allied health service use through team care planning, while any alcohol consumption and adequate physical activity were found to be associated with a lower risk of developing obesity. In the healthy weight group, high psychological distress and the use of antiepileptics were associated with developing obesity. In the overweight group, female sex and full-time work were associated with developing obesity, while older age was found to be associated with a lower risk of developing obesity.</p><p><strong>Conclusions: </strong>These findings may inform the targeting of preventive interventions for obesity in clinical practice and broader public health programs.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":"680-692"},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140119209","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}