Family Medicine and Community Health最新文献

{"title":"Primary care provider and clinic staff perspectives on the collection of demographic and social needs data in primary care clinics across five Canadian provinces.","authors":"Archna Gupta, Joseph J O'Rourke, Leanne Kosowan, Dana Howse, Lane Williams, Itunuoluwa Adekoya, Abigail Zita Seshie, Alannah Delahunty-Pike, Mélanie Ann Smithman, Eunice Abaga, Alexander Zsager, Marjeiry Robinson, Emily Gard Marshall, Kris Aubrey-Bassler, Cory Neudorf, Nazeem Muhajarine, Isabelle Fortuna, Andrew D Pinto","doi":"10.1136/fmch-2025-003686","DOIUrl":"10.1136/fmch-2025-003686","url":null,"abstract":"<p><strong>Objective: </strong>This study reports on the barriers and facilitators experienced by primary care providers, clinic staff and clinic leadership when implementing the SPARK Tool to collect demographic and social needs data in primary care clinics across Canada.</p><p><strong>Design: </strong>A qualitative process evaluation was conducted using semistructured interviews and focus groups to identify facilitators and barriers to implementing the SPARK Tool, comprising 20 demographic and social needs questions, in primary care. A SPARK Tool Implementation Logic Model was developed to guide the implementation process.</p><p><strong>Setting: </strong>The SPARK Tool was implemented over 6 months, from September 2022 to October 2023, at five primary care clinics across five Canadian provinces.</p><p><strong>Participants: </strong>49 participants, including primary care providers, clinic staff and leadership, participated in an interview or focus group as part of this 6-month implementation study.</p><p><strong>Results: </strong>Key facilitators included leadership support, the clinic's context (eg, staff availability and engagement, multidisciplinary teams), staff training and the provision of accessible materials. Barriers involved technological challenges, time constraints, privacy concerns and language limitations. Overall, the SPARK Tool facilitated the systematic and routine collection of demographic and social needs data, supporting individualised care plans informed by a more comprehensive capture of patient needs. The SPARK Tool Implementation Logic Model was adapted based on the findings of this study, which represent the adapted model's core components, including prerequisites, inputs, activities, outputs and outcomes.</p><p><strong>Conclusions: </strong>The study highlighted the potential of the SPARK Tool to integrate demographic and social needs data into primary care workflows, thereby improving individualised care and facilitating clinic-level service planning. It emphasised the importance of addressing barriers to ensure equitable implementation and long-term success.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146259326","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":"Risk factors for COPD exacerbations and mortality, and variation between primary care settings: the PRAXIS cohort study in Sweden.","authors":"Carolina Smith, Ayako Hiyoshi, Tor Arnison, Gabriella Eliason, Maaike Giezeman, Mikael Hasselgren, Christer Janson, Mikael Karlsson, Marta A Kisiel, Karin Lisspers, Anna Nager, Hanna Sandelowsky, Björn Ställberg, Josefin Sundh, Scott Montgomery","doi":"10.1136/fmch-2025-003713","DOIUrl":"10.1136/fmch-2025-003713","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to examine the variability of chronic obstructive pulmonary disease (COPD) exacerbations and mortality, between primary healthcare centres, and their associations with comorbid diseases and body mass index, during an 8-year follow-up.</p><p><strong>Design: </strong>This was a cohort study using multilevel modelling with follow-up from 2014 to 2022. Data came from questionnaires in 2014 and 2022 and medical record reviews between 2004 and 2014. The main outcomes were exacerbations in 2022 and mortality by 2022. Exacerbations were defined as any emergency visit, and/or use of oral steroids or antibiotics due to worsening of COPD symptoms during the previous 6 months.</p><p><strong>Setting: </strong>The PRAXIS study included patients at 76 primary healthcare centres in central Sweden.</p><p><strong>Participants: </strong>Primary care patients aged ≤75 years and with a diagnosis of COPD in their medical records between 2007 and 2010 were included in 2014 (n=1163) and followed up in 2022 (n=906). There were no other exclusion criteria.</p><p><strong>Results: </strong>The 809 patients with complete data attended 70 primary care centres. Multilevel multinomial regression estimated risks of exacerbations and mortality, calculating relative risk ratios (RRRs) with 95% CIs. The intraclass correlation coefficient (ICC) quantified the proportion of variance attributed to variability between centres. The ICC was 0.024, indicating 2.4% of the variation was explained by differences between centres. Patients with a history of depression in 2014 had an increased risk of subsequent exacerbations (RRR 1.95, 95% CI 1.13 to 3.39). For mortality, there were associations with history of anxiety, RRR 3.71 (95% CI 2.06 to 6.87), or cardiovascular disease, especially chronic heart failure, RRR 2.69 (95% CI 1.36 to 5.33). Body mass index had a U-shaped association with mortality.</p><p><strong>Conclusions: </strong>The variability between centres was small and patient factors appear to be of more importance for COPD exacerbations and mortality than differences between these primary care settings. As expected, pre-existing cardiovascular disease is associated with future excess mortality risk, but, notably, anxiety may also be an important risk factor. Individualised care and management of comorbidity is thus essential among patients in primary care with COPD.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146259493","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":"EASE-CEA: an Italian general practice reform model balancing autonomy and accountability in Italy's primary care.","authors":"Claudio Cricelli, Walter Ricciardi, Vincenzo Atella, Federico Serra","doi":"10.1136/fmch-2025-003455","DOIUrl":"10.1136/fmch-2025-003455","url":null,"abstract":"","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 2","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127034","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":"Uncertainty in general practice: a myth of uniqueness?","authors":"Michael Tran, Parker Magin, Wendy Hu, Joel Rhee, Boaz Shulruf","doi":"10.1136/fmch-2025-003592","DOIUrl":"10.1136/fmch-2025-003592","url":null,"abstract":"<p><p>Uncertainty is widely regarded as a defining feature of general practice, with its tolerance and management considered core competencies in training and professional identity formation. The effects of uncertainty have educational, economic and clinical implications for general practitioners. There is an axiomatic assertion that uncertainty is unique in general practice: being more present, more keenly experienced and of more personal and clinical consequence than in other medical specialties. This truism exists in the absence of supporting empirical evidence, potentially exposing it as a medical education myth. Understanding where the myth originates and how it is perpetuated is important, particularly for those experiencing and learning about uncertainty.To examine this claim, a review of the existing literature was conducted, followed by a historical analysis to trace the origins and perpetuation of this belief. The notion of uncertainty as a hallmark of general practice emerged alongside its establishment as a distinct specialty, framed as a humanist and relational discipline. Contemporary literature continues to reinforce this view, often positioning uncertainty as a marker of 'good' general practice. Yet, this reinforcement may be shaped by confirmation bias, rooted in the uncritical acceptance of the original claim.Interrogating whether uncertainty is truly unique to general practice, or instead a universal aspect of medical work, can help identify which elements are amenable to educational intervention. Challenging the myth may reduce the perceived burden of uncertainty and foster a growth mindset among learners, encouraging more constructive engagement with uncertainty in both undergraduate and postgraduate settings.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146067609","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":"Model for bridging the gap: establishing an oncology primary care clinic for comprehensive survivorship care.","authors":"Alique Gabrielle Topalian, Melissa Erickson, Tess Brewer, Sophie Kushman, Eizabeth Shaughnessy, Melinda Butsch Kovacic","doi":"10.1136/fmch-2025-003707","DOIUrl":"10.1136/fmch-2025-003707","url":null,"abstract":"<p><strong>Objective: </strong>To describe the development, implementation and impact of an oncology primary care clinic within a tertiary cancer centre, designed to enhance survivorship care and ensure continuity for patients with complex cancer histories.</p><p><strong>Design: </strong>Descriptive review of clinic formation, team structure, training and patient outcomes. Data were collected from electronic medical records, a Patient Outcomes Registry in Research Electronic Data Capture (REDCap) and institutional dashboards. Patient experience was assessed using the Consumer Assessment of Healthcare Providers and Systems Survey, and oncology provider feedback was obtained through written testimonials. Descriptive statistics and frequencies summarise findings.</p><p><strong>Setting: </strong>University of Cincinnati Cancer Center, a Midwestern tertiary care facility, where the oncology primary care clinic was established in 2020.</p><p><strong>Participants: </strong>Patients who visited the clinic between January 2021 and June 2025 (N=1138). Patient satisfaction data were available for 288 respondents.</p><p><strong>Results: </strong>Through June 2025, the clinic saw 1138 unique patients. The majority had adult-onset cancers (87.8%), while a smaller, yet substantial number had childhood (4%), adolescent or young adult (8.3%) onset cancers. Second primary malignancies were documented in 15.7% of the clinic population. Over half of the patients had cardiovascular conditions. Between January 2021 and April 2025, patient satisfaction was high across all domains (N=288). Oncology provider feedback highlights the critical role of an integrated oncology primary care clinic in the management of patients with complex cancer diagnoses.</p><p><strong>Conclusions: </strong>The establishment of an oncology primary care clinic within a tertiary cancer centre is both feasible and impactful. The clinic's growth and high satisfaction scores underscore its value in addressing the complex needs of cancer survivors. Integrating primary care into oncology settings enhances continuity of care, improves management of comorbidities and supports long-term survivorship. The use of a Patient Outcomes Registry enables ongoing evaluation and quality improvement. This model offers a scalable framework for other institutions seeking to advance comprehensive survivorship care.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 Suppl 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12815062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991321","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":"Incretin-based therapies for obesity and disordered eating: optimising care in general practice.","authors":"Evan Atlantis, Rebecca Wu, John Dixon","doi":"10.1136/fmch-2025-003622","DOIUrl":"10.1136/fmch-2025-003622","url":null,"abstract":"","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 Suppl 2","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12815131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991388","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":"Australian General Practitioners' perspectives, experiences and use of non-drug interventions in primary care: a qualitative study.","authors":"Alexandra R Davidson, Hannah Greenwood, Isabella Maugeri, Caroline Katherine Dowsett, Loai Albarqouni","doi":"10.1136/fmch-2025-003741","DOIUrl":"10.1136/fmch-2025-003741","url":null,"abstract":"<p><strong>Objective: </strong>Non-drug interventions (NDIs) are underused in primary care, despite established effectiveness, safety, cost-benefit and guidelines. Existing research exploring barriers and enablers to NDI use primarily focuses on patients' perspectives, leaving general practitioners' (GPs') perspectives underexplored, despite their critical role in NDI delivery. The objective of this study is to explore Australian GPs' experiences and perspectives on the use of NDIs in primary care.</p><p><strong>Design: </strong>An interview study informed by realist methodology. Transcripts were abductively analysed, with a sample analysed by two researchers, using the Theoretical Domains Framework, which allows identification of individual and contextual factors that influence behaviour, and discussed in team meetings to develop themes.</p><p><strong>Setting: </strong>Interviews took place either in person or online via Zoom, were audio-recorded and transcribed verbatim.</p><p><strong>Participant: </strong>A convenience sample of GPs working in Australian primary care.</p><p><strong>Result: </strong>14 GPs were interviewed for an average of 59 min. Four themes were developed representing the latent mechanisms underlying GPs' prescription and use of NDIs. (1) Obtaining and sharing knowledge: GPs' learning about NDIs is limited through medical school and continuing education, highlighting gaps in tertiary and specialty training. Sharing knowledge occurs bidirectionally. GPs share their learnt knowledge about NDIs with patients, who in turn share their lived experience knowledge. (2) Considering the patient: patient characteristics, circumstances and actual or perceived expectations influenced GPs' NDI prescription. Influences included financial status, therapeutic relationship, patient motivation, presenting condition and medication expectation. (3) Influence of primary care environment: time constraints, billing and policies influenced when and how GPs used and prescribed NDIs. Interprofessional collaboration and distributing patient resources were strategies used by GPs to overcome barriers. (4) NDIs part of GPs' role and identity: NDIs were prescribed as first-line treatments, preventative strategies or as an adjuvant to medication for both acute or chronic conditions, highlighting NDIs as core to GPs' role and care.</p><p><strong>Conclusion: </strong>This study reveals the interplay of factors and mechanisms influencing Australian GPs' use of NDIs, including systemic, educational and interpersonal dynamics. To optimise the integration of NDIs in primary care, prioritised training, clearer guidance and better access to evidence-based resources are required.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"14 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12778305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913321","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":"Guidelines on primary healthcare for type 2 diabetes in China, 2025.","authors":"Weiping Jia, Dalong Zhu, Lixin Guo, Liming Chen, Chun Cai, Jun Song","doi":"10.1136/fmch-2025-003765","DOIUrl":"10.1136/fmch-2025-003765","url":null,"abstract":"<p><p>In recent years, the prevalence of diabetes in China has increased significantly, and approximately 11.9% of Chinese adults had diabetes in 2020. Moreover, there are several rigorous challenges in diabetes prevention and glycaemic control, especially at the primary medical care level. In order to guide primary healthcare providers in providing comprehensive and continuous care to affected patients, the Office for Primary Diabetes Care of the National Basic Public Health Service Program and the Chinese Diabetes Society issued national guidelines for the prevention and control of diabetes at the primary care level in 2025. The management objects were adults with type 2 diabetes aged ≥18 years. The main contents include basic requirements for management, health management process, diagnosis, screening, evaluation, treatment, recognition and management of acute complications, traditional Chinese medicine, referral and health management and education.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"13 4","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12766796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865877","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":"Burden and risk factors of mental and substance use disorders among children aged 5-14 in Asia from 1990 to 2021: results from the Global Burden of Disease study.","authors":"Yanyan Wang, Huifang Yang, Yizhen Wu, Jiahui Li, Chikyu Tsin, Shuyang Ren, Jun Zhang, Yuling Qiao, Xiwang Fan","doi":"10.1136/fmch-2025-003441","DOIUrl":"10.1136/fmch-2025-003441","url":null,"abstract":"<p><p>‌OBJECTIVE: To analyse trends in mental and substance use disorders among Asian children aged 5-14 years, identify key risk factors (eg, bullying, abuse, lead exposure) and compare gender/age disparities using Global Burden of Disease (GBD) 2021 data. ‌DESIGN: Cross-sectional analysis of the GBD 2021 database, focusing on prevalence, disability-adjusted life years (DALYs) and risk factor associations. ‌SETTING: Population-based study across Asian countries, examining the burdens of mental health, especially substance use disorders in high-prevalence regions. ‌PARTICIPANTS: Children aged 5-14 years in Asia, with gender-stratified subgroups (boys vs girls). ‌RESULT: Anxiety, conduct disorders and autism were primary contributors to mental health burdens. Substance use disorders, though less prevalent, rose notably among boys. Girls showed higher burdens of anxiety/depressive disorders. Bullying and childhood abuse were strongly linked to these conditions. Gender disparities in DALYs highlighted boys' vulnerability to substance use and girls to internalising disorders. ‌CONCLUSION: Urgent, region-specific interventions are needed to address bullying, lead exposure and abuse, with gender-sensitive strategies. The study calls for targeted research and policies to mitigate rising mental health challenges in Asian children.</p>","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"13 4","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12742091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834841","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":"Changes to the use of medicines containing the antibiotic azithromycin.","authors":"Robin Ruepp, Radu Botgros, Veronique Le Ber, Franziska Brandt, Ellen Pantke, Miriam Fuerst-Wilmes, Antonio Gomez-Outes, Maria Jesus Fernandez-Cortizo","doi":"10.1136/fmch-2025-003699","DOIUrl":"10.1136/fmch-2025-003699","url":null,"abstract":"","PeriodicalId":44590,"journal":{"name":"Family Medicine and Community Health","volume":"13 4","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12750746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834830","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}