Family Medicine and Community Health最新文献

{"title":"Effects of age at first separation from parents on suicidal ideation, suicide planning and suicide attempts among left-behind children: the causal mediating effect of traumatic events.","authors":"Xian Wu, Xiaobing Zhai, Jiangxue Wang, Yudu Liu, Yuanyuan Wu, Yangxi Huang, Miao Zhou, Bing Xiang, Mei Yang, Xinyan Xie, Jing Zeng","doi":"10.1136/fmch-2025-003349","DOIUrl":"https://doi.org/10.1136/fmch-2025-003349","url":null,"abstract":"<p><strong>Background: </strong>To investigate the relationship of age at first separation from parents (AFSP) with suicidal ideation (SI), suicide planning (SP) and suicide attempts (SA) among left-behind children (LBC) in China and the mediating effect of traumatic events (TEs).</p><p><strong>Methods: </strong>This cross-sectional study employed a multistage sampling method to conduct questionnaire surveys in six high-concentrated LBC provinces. Logistic regression and restricted cubic splines were performed to investigate the association of AFSP with SI, SP and SA, and meta-analysis (I²) was used to assess the heterogeneity. Causal mediation analysis (structural equation modelling) was used to evaluate the mediating effect of TEs, and bootstrap resampling was employed to assess the robustness of the causal mediation analysis.</p><p><strong>Results: </strong>A total of 12 162 (6269 LBC) participants were included in this study; the prevalence rates of SI, SP and SA among LBC were 30.7%, 18.6% and 11.9%; and LBC had a higher risk of SI (OR: 1.32), SP (OR: 1.40) and SA (OR: 1.25) than non-LBC, all p<0.001. AFSP was negatively associated with SI, SP and SA, particularly peaking before 2 years old. LBC with AFSP <2 years old had a higher risk of SI (OR 2.65; 95% CI 2.17 to 3.24; p<0.001), SP (OR 2.63; 95% CI 3.36 to 4.29; p<0.001) and SA (OR 2.04; 95% CI 2.73 to 3.63; p<0.001). TEs mediated the increased risk of SI (average causal mediation effect (ACME) 0.03-0.07; proportion (Prop) 40-54%; all p<0.001), SP (ACME 0.03-0.06; Prop 39-61%; all p<0.001) and SA (ACME 0.02-0.04; Prop 53-80%; all p<0.01).</p><p><strong>Conclusions: </strong>We found that AFSP was associated with SI, SP and SA, mediated by TEs. Our findings supported the necessity of reducing SI, SP and SA risks among LBC and highlighted the need to consider AFSPs and TEs in intervention strategies.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"13 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences, perceptions and attitudes on providing advice on physical activity to patients with chronic ischaemic heart disease: a qualitative study in general practitioners in Germany.","authors":"Alicia Prinz, Sabrina Hoppe, Verena Leve, Rik Crutzen, Norbert Donner-Banzhoff, Stefan Wilm, Sabrina Kastaun","doi":"10.1136/fmch-2024-003124","DOIUrl":"10.1136/fmch-2024-003124","url":null,"abstract":"<p><strong>Background and objective: </strong>The WHO emphasises the importance of integrating advice on physical activity (PA) into primary care of patients with chronic ischaemic heart disease (IHD). Similarly, the German treatment guideline 'Chronic Coronary Heart Disease' recommends that general practitioners (GPs) provide advice on PA to IHD patients. However, the provision of PA advice seems to be inadequately implemented in general practice. One reason is the lack of medical training in providing PA advice effectively and efficiently. International guidelines recommend such training for health professionals. This study aims to explore experiences, perceptions and attitudes, including barriers and facilitators of GPs towards the routine delivery of PA advice to IHD patients.</p><p><strong>Methods: </strong>Between March and June 2023, 12 face-to-face problem-centred interviews and six focus group discussions (n=37) with GPs were conducted. Interview and discussion guides were developed and pilot tested by the multi-professional study team. We used a purposive sampling strategy, and data were collected in an iterative process. Audio-recorded data were transcribed verbatim and analysed using a content structuring procedure (deductive and inductive approach). GPs were involved throughout the entire research process, for example, in multi-professional analysis groups.</p><p><strong>Results: </strong>Although GPs are mostly aware of the health benefits of PA for patients with IHD, PA advice is not routinely provided. Conversations on PA tend to be rather unstructured, and advice is often addressed more generally than customised to the patients' needs and preferences. Priority is given to other lifestyle issues, such as smoking cessation. PA advice is perceived as time-consuming and rather ineffective with regard to the target behaviour. GPs frequently express frustration in this context. GPs express a lack of and simultaneously a need for communication strategies (structure and tools) that can be integrated into everyday GP practice to motivate patients to PA.</p><p><strong>Conclusion: </strong>The results provide relevant insights into the current practice of GPs with regard to their attitudes on, experiences with, and requirements for the provision of PA advice to IHD patients. These results are helpful to inform the development of appropriate GP training in the provision of very brief PA advice to IHD patients.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"13 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/fmch-2025-003434","DOIUrl":"10.1136/fmch-2025-003434","url":null,"abstract":"","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"13 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescribing medications to patients living with a visual impairment: a qualitative study of physicians to explore their usual clinical practices.","authors":"Théodora Merenda, Zélie Sibilles, Jennifer Denis, Jean-Pierre Sabot, Stéphanie Patris","doi":"10.1136/fmch-2024-003253","DOIUrl":"https://doi.org/10.1136/fmch-2024-003253","url":null,"abstract":"<p><strong>Objectives: </strong>Visual impairment is a disability affecting a large number of people worldwide, who are more likely to experience difficulties in their daily lives, impacting on their quality of life, independence, mobility and state of health. However, there is a lack of progress in the field of healthcare for individuals living with a visual impairment. The objectives of this study were (1) to illustrate the usual clinical practices of physicians to support the care of individuals with a visual impairment and (2) to identify the components considered to reduce risks resulting from the prescription of medications to these individuals.</p><p><strong>Methods and analysis: </strong>Semi-structured interviews were conducted with French-speaking physicians via videoconference in Belgium. Participants were recruited voluntarily and using the snowball method. An interview guide was developed to meet the objectives of the study. Interviews were carried out until theoretical data saturation, recorded, transcribed <i>verbatim</i> and analysed in a double-blind fashion using thematic analysis. Data were organised using NVivo V.14 software.</p><p><strong>Results: </strong>Three themes were addressed in the 24 interviews: consultation with patients with a visual impairment, prescribing medications to patients with a visual impairment and medication risk management for patients with a visual impairment. Most participants reported that they had not received specific education in visual impairment. Some physicians reported that they did not differentiate between patients living with a visual impairment and other patients, while others reported taking some additional measures.</p><p><strong>Conclusions: </strong>This qualitative study highlighted a lack of knowledge and awareness among physicians regarding visual impairment and at-risk medications in these patients. The development of recommendations and tools is a solution to improve the quality of care for patients living with a visual impairment.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"13 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty reversal and its main determinants: a population-based observational and longitudinal study.","authors":"Mateu Serra-Prat, Aida Fortuny Borsot, Emili Burdoy, Àngel Lavado Cuevas, Laura Muñoz Ortiz, Mateu Cabré","doi":"10.1136/fmch-2024-003250","DOIUrl":"https://doi.org/10.1136/fmch-2024-003250","url":null,"abstract":"<p><strong>Background: </strong>Clinical guidelines recommend frailty screening for the aged population, given that frailty is frequently reversible. However, little is known about frailty and prefrailty reversal rates in the general population if no specific interventions have been implemented.</p><p><strong>Aim: </strong>To assess real-world frailty and prefrailty reversal rates in the general population aged ≥65 years, the main contributing clinical conditions and the main risk factors for reversing frailty and prefrailty.</p><p><strong>Methods: </strong>Observational longitudinal 12-month study (2019) of all 1·5 million persons aged ≥65 years in Catalonia. Data were retrospectively collected from various health databases through the Catalan Public Data Analysis for Health Research and Innovation (PADRIS) V.2022 programme. Frailty status according to the electronic Screening Index for Frailty (e-SIF) was determined for 31 December 2018 and for 31 December 2019.</p><p><strong>Results: </strong>The study included 1 465 312 Catalan inhabitants (mean age 75.8 years, 57.0% women). The annual frailty and pre-frailty reversal rates were 7.1% and 4.6%, respectively. Both rates were higher in men and decreased with age. The e-SIF components with the greatest impact on frailty reversal were non-planned hospitalisations, polypharmacy, orthostatic hypotension or syncope, anaemia and visual impairment. Female sex, age, dependency, ≥2 comorbidities and polypharmacy had an independent protective effect on 12-month frailty and pre-frailty reversals.</p><p><strong>Conclusions: </strong>Prefrailty and frailty are reversible, but reversal is unlikely in cases of multimorbidity, polypharmacy and functional dependency in older and severely frail individuals. Interventions that mainly target the avoidance of non-planned hospitalisations, polypharmacy and falls would have the greatest impact on reversing frailty and pre-frailty.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"13 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of the COVID-19 pandemic on individuals with chemical intolerance.","authors":"Raymond F Palmer, David Kattari, Monica Verduzco-Gutierrez","doi":"10.1136/fmch-2024-003081","DOIUrl":"https://doi.org/10.1136/fmch-2024-003081","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to determine if the COVID-19 pandemic had differential effects on individuals with chemical intolerances (CI). CI is characterised by multisystem symptoms initiated by a one-time high dose or persistent low-dose exposure to environmental toxins including chemicals, foods and drugs. With an estimated 20% US prevalence, symptoms include fatigue, headache, weakness, rash, mood changes, musculoskeletal pain, gastrointestinal issues, difficulties with memory, concentration and respiratory problems, which are similar to COVID-19 and its sequelae.</p><p><strong>Design: </strong>A US population-based survey involving 7500 respondents was asked if they ever had COVID-19, what the severity was, and if they had long COVID-19. CI was assessed using the Quick Environmental Exposure and Sensitivity Inventory.</p><p><strong>Setting: </strong>The Center for Disease Control estimates that over 24 million have been infected with COVID-19 in the USA with over 6 700 000 being hospitalised and over 1 174 000 deaths. Other industrialised countries show similar numbers.</p><p><strong>Results: </strong>Those in the High CI class reported a greater COVID-19 prevalence, symptom severity and long COVID-19 than in the medium and low CI groups (p<0.0001). These associations were independent of race, ethnicity, income, age and sex. However, there were significantly increased odds of COVID-19 severity among women and those over 45 years old. Asian individuals were least likely to have severe symptoms compared with white individuals (OR=0.53; 95% CI 0.35 to 0.79). Black/African American individuals reported a lower prevalence of COVID-19 than non-Hispanic whites. However, one interaction between CI and race was significant, African Americans with high CI reported greater odds (OR=2.2; 95% CI 1.15 to 3.16) of reporting COVID-19 prevalence. Furthermore, African American individuals had significantly greater odds of increased symptom severity.</p><p><strong>Conclusion: </strong>Prior studies show higher risk for COVID-19 among older age groups, male sex, those with pre-existing comorbidities (eg, challenged immunities) and those from minoritised racial/ethnic groups. The results of this study suggest that those with CI be included in a high-risk group. Various risk subsets may exist and future investigations could identify different risk subsets. Understanding these subgroups would be helpful in mounting targeted prevention efforts.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"13 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of different types of physical exercise on sleep quality in older population with insomnia: a systematic review and network meta-analysis of randomised controlled trials.","authors":"Pakwan Bahalayothin, Kittiphon Nagaviroj, Thunyarat Anothaisintawee","doi":"10.1136/fmch-2024-003056","DOIUrl":"10.1136/fmch-2024-003056","url":null,"abstract":"<p><strong>Objective: </strong>To measure the impact of each type of exercise on sleep quality and identify the exercise that enhances sleep quality the most.</p><p><strong>Study selection: </strong>Eligible randomised controlled trials that compare physical exercise to routine activities, usual care, non-physical activity, or health education to measure the Pittsburgh Sleep Quality Index.</p><p><strong>Data source: </strong>Studies retrieved from Medline, Embase, CINAHL, Scopus, ClinicalTrial.gov and ThaiJo from the database's inception to October 2022.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently identified studies, collected data and assessed bias. In the absence of heterogeneity, a fixed effect model was used for pairwise meta-analysis. Alternatively, a random effect model was used. A two-stage network meta-analysis used the surface under the cumulative ranking curve (SUCRA) to compare exercise efficacy.</p><p><strong>Main outcome: </strong>Global Pittsburgh Sleep Quality Index (GPSQI) and subdomain score.</p><p><strong>Results: </strong>This review comprised 2170 people from 25 trials. Direct meta-analysis revealed significant improvement in GPSQI with combined exercise (unstandardised mean difference (USMD) -2.35, 95% CI-3.13 to -1.57, p<0.001, I²=69.13%). GPSQI decreased considerably with aerobic activity (USMD -4.36, 95% CI -7.86 to -0.86, p=0.01, I²=97.83%). For the network meta-analysis, strengthening, aerobic and combination exercise significantly lowered GPSQI (USMD-5.75, -3.76 and -2.54, respectively). Strength training improved GPSQI scores most effectively (SUCRA 94.6%).</p><p><strong>Conclusion: </strong>Exercise that strengthens muscles, rather than aerobic or combination exercises, is the most effective way to enhance sleep quality.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current and new treatment options for adults recently diagnosed with type 2 diabetes.","authors":"Tamara K Oser, Catherine Varney, Anthony L McCall, Daniel J Cox","doi":"10.1136/fmch-2024-003154","DOIUrl":"10.1136/fmch-2024-003154","url":null,"abstract":"","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical decision fatigue: a systematic and scoping review with meta-synthesis.","authors":"Nicola Grignoli, Greta Manoni, Jvan Gianini, Peter Schulz, Luca Gabutti, Serena Petrocchi","doi":"10.1136/fmch-2024-003033","DOIUrl":"10.1136/fmch-2024-003033","url":null,"abstract":"<p><strong>Objective: </strong>Decision fatigue (DF) can lead to impaired judgement, decreased diagnostic accuracy and increased likelihood of medical errors. Research on DF is scarce, and little is known about its nature in the clinical context. The objective of the present review was to provide a comprehensive framework to understand how the construct of DF in medical settings has been defined and measured. This review aimed to understand DF determinants and consequences and capture motivational factors overlooked in the existing reviews.</p><p><strong>Design: </strong>Systematic and scoping review (ScR) with meta-synthesis.</p><p><strong>Eligibility criteria: </strong>Empirical and non-empirical papers on clinical DF or related constructs directly impacting clinical decision-making were considered, with doctors of all ages, sexes and nationalities as participants. The Preferred Reporting Item for Systematic Reviews and Meta-analyses scoping review checklist has been applied and checked.</p><p><strong>Information sources: </strong>Six databases were systematically searched by two independent researchers according to a predefined set of keywords.</p><p><strong>Results: </strong>43 papers were included, of which 25 were empirical. The quantitative studies outnumber the qualitative ones and primarily involved residents in Europe/UK and North America. Internal medicine and primary care were the most studied disciplines. Only one sequential cross-sectional study measured DF in the medical setting, and all other studies addressed the construct indirectly. A conceptual analysis of clinical DF, including narrative contributions, a thematic analysis of the data extracted and a meta-synthesis, is provided. Clinical DF was investigated mostly by individual risk factors analysed through multiple intertwined determinants involving cognitive, emotional, behavioural, social and ethical aspects. Relevant risks, protective factors and negative outcomes circularly increasing DF are outlined.</p><p><strong>Conclusions: </strong>The review gives solid arguments for developing a clear and coherent definition of clinical DF that allows the implementation of preventive targeted intervention.</p><p><strong>Prospero registration number: </strong>This systematic review was pre-registered in PROSPERO on 8 November 2023 (available online at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023476190, registration number CRD4202347619).</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scope of practice of Japanese primary care physicians and its associated factors: a cross-sectional study.","authors":"Tomoya Higuchi, Mieko Nakamura, Toshiyuki Ojima, Machiko Inoue","doi":"10.1136/fmch-2024-003191","DOIUrl":"10.1136/fmch-2024-003191","url":null,"abstract":"<p><strong>Objective: </strong>The scope of practice (SOP) of primary care physicians (PCPs) has been narrowing, with declining comprehensiveness leading to fragmented care. Identifying SOP-associated factors can help improve comprehensiveness. This study aimed to describe the SOP of PCPs working in clinics and to identify SOP-associated factors.</p><p><strong>Design: </strong>A cross-sectional study using a self-administered questionnaire.</p><p><strong>Setting: </strong>Shizuoka, Japan.</p><p><strong>Participants: </strong>PCPs working in clinics offering internal medicine.</p><p><strong>Main outcome measures: </strong>The total number of services provided, covering 109 items, was categorised into 8 clinical areas, 78 clinical activities and 23 procedures.</p><p><strong>Results: </strong>Questionnaires were mailed to 1191 clinics, and 389 valid responses were included in the analysis. Of the 389 physicians, 254 (65.3%) were internal medicine specialists, and 382 (98.2%) worked in their own private clinics. The mean number of services provided was 60.4±17.4. Clinical activities were provided less frequently in the areas of paediatric and adolescent care, women's health, home healthcare, palliative care and mental health. Physician-related factors were more significantly associated with SOP than practice or environmental factors. Preference for broad practice was the strongest factor associated with a broader SOP, followed by completion of the Japan Medical Association (JMA) primary care training programme and rotational training experience. Additionally, younger physician age, rural practice experience, surgical specialisation, a larger number of physicians in the clinic, higher patient volume and a more rural setting were associated with broader SOP.</p><p><strong>Conclusion: </strong>Physician preference regarding SOP, completion of the JMA primary care training programme and rotational training are key factors influencing SOP. These findings suggest that postgraduate clinical training with a broad scope not limited to internal medicine and continuing medical education after establishing a private clinic, particularly for physicians who prefer broad practice, may be important in expanding the SOP of PCPs.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}