Journal of Primary Care and Community Health最新文献

{"title":"Barriers and Facilitators to Colorectal Cancer Screening Among Health Fair Attendees in Utah.","authors":"Jordan E Johnson, Svenja Pauleck, Andrea J H Williamson, Maranda Pahlkotter, Federica S Brecha, Nathaniel Ferre, Nancy Ortiz, Robin L Marcus, Sheetal Hardikar, Jessica N Cohan","doi":"10.1177/21501319251316659","DOIUrl":"10.1177/21501319251316659","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) screening uptake remains suboptimal despite the importance and effectiveness of various testing options. The purpose of our study was to identify barriers and facilitators to CRC screening in a community-based sample in Salt Lake County, Utah to inform future efforts to develop effective interventions to increase CRC screening.</p><p><strong>Methods: </strong>This study enrolled adults eligible for CRC screening at 6 community health events. Participants completed targeted questionnaires based on whether they had discussed screening with a provider and whether they had received screening. We identified participant-reported barriers to CRC screening using descriptive analysis. Univariate and multivariate analyses were used to identify participant characteristics associated with receipt of screening.</p><p><strong>Results: </strong>Of the 117 participants who completed the questionnaires, 43.6% were 50 to 60 years old, 36.8% identified as white, and 51.3% identified as non-Hispanic. The most common barrier to colonoscopy was the need for extensive bowel preparation (30.8%). For stool tests, common barriers included handling stool (20.5%) and not understanding how to do the test (20.5%). For virtual colonoscopy, barriers included the need for extensive bowel preparation (21.4%) and cost (21.4%). Most participants (67.5%) believed that they should know about all CRC screening options available, and their importance. The majority of participants (68.4%) preferred to learn about CRC screening from their doctor or healthcare provider. Younger age was associated with non-screening.</p><p><strong>Conclusion: </strong>We observed that study participants faced procedural barriers to complete CRC screening and preferred to learn about CRC screening options through their providers. Younger age groups were less likely to receive screening within our study sample. Future, targeted interventions to increase CRC screening should focus on increasing the awareness of the importance of CRC screening and educating patients on the various screening options available and their benefits, especially as they pertain to less invasive tests and targeting younger individuals.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251316659"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General Practitioners' Needs and Preferences Regarding the Provision of Self-sampling Tests for Cervical Cancer Screening in Flanders, Belgium.","authors":"Eva Gezels, Sara Willems, Katrien Vanthomme, Lien Keersse, Kaatje Van Roy","doi":"10.1177/21501319251320178","DOIUrl":"10.1177/21501319251320178","url":null,"abstract":"<p><strong>Background: </strong>Screening coverage for cervical cancer remains suboptimal in Flanders, Belgium. The upcoming transition to primary HPV screening in January 2025 presents an opportunity to offer self-sampling kits (SSKs) as an alternative to conventional Pap smears, with the potential to increase participation rates. General practitioners (GPs) can play a crucial role in reaching under-screened populations. Hereto it is essential to understand the needs and preferences of GPs regarding the integration of SSKs into their routine practice.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with GPs participating in an implementation study on the added value of SSKs for long-term non-screened women, focusing on their experiences, challenges, and suggestions regarding the provision of SSKs to these patients.</p><p><strong>Results: </strong>The interviewed GPs recognized the potential of SSKs to increase participation, particularly due to their less invasive nature, which makes them more acceptable to underscreened women. Time constraints, technical software challenges, limited knowledge and doubt about SSK accuracy were identified as key barriers to implement SSKs in routine practice. GPs emphasized the need for adaptability in the distribution methods of SSKs, with many preferring a combination of mailing the SSKs and providing them in person. Personalized communication and tailored explanations were considered as crucial to ensure patient acceptance and the correct use of the tests.</p><p><strong>Conclusion: </strong>This study shows that while GPs recognize the potential of SSKs to enhance cervical cancer screening, several challenges need to be addressed for their effective integration into primary care. A successful approach should incorporate streamlined support systems, tailored approaches to implement reminders for GPs and improved education for GPs. Future research should consider quantitative data on the effectiveness and cost-efficiency of SSKs in the specific context of Flanders and the perspectives of a broader range of stakeholders, including patients, practice nurses, gynecologists and policymakers, to develop more comprehensive strategies for the successful implementation of SSKs.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251320178"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions for Reducing Screen Time of Preschoolers: A Systematic Review of Randomized Controlled Trials.","authors":"Markel Rico-González, Eivind Holsbrekken, Ricardo Martín-Moya, Luca Paolo Ardigò","doi":"10.1177/21501319241306699","DOIUrl":"10.1177/21501319241306699","url":null,"abstract":"<p><p>Preschool-aged children are growing up in an environment saturated with screens, which provokes a significant public health issue, given its potential associations with adverse physical, cognitive, and psychosocial outcomes. The present article aims to systematically summarize the interventions for reducing screen time in preschool-aged children. A systematic review of relevant articles was carried out using 5 main databases until October 15, 2023. From 71 studies initially found, eight were included in the qualitative synthesis. It was provided a methodological assessment of various studies based on 10 criteria, with scores ranging from 12 to 20 out of the total possible score, indicating the extent to which each study adhered to key methodological standards. Various interventions targeting preschool-aged children's screen time showed mixed results. While some, like the Parents' Screen Time Reduction Program, led to significant reductions in screen time and improved parental attitudes and behaviors, others, such as short counseling interventions, did not yield significant changes. Screen time among preschoolers can be effectively reduced by targeting parents' knowledge and attitude through comprehensive, parent-involved approaches involving repeated reinforcement and teaching them about the consequences of screen time and how they can proceed to reduce it for their children.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319241306699"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications Derived from Global Experiences of Barriers to Integrating Community Pharmacists into Primary Healthcare: A Scoping Review.","authors":"Fatemeh Homayounifar, Mohsen Khosravi, Ghazal Davar, Manica Negahdaripour, Hassan Joulaei","doi":"10.1177/21501319251371825","DOIUrl":"10.1177/21501319251371825","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Primary healthcare (PHC) is a comprehensive and efficient system that promotes people's health by providing a range of services in easily accessible locations. Integrating pharmacists into PHC has emerged as a promising approach to enhance healthcare delivery. This study aimed to explore the barriers to integrating community pharmacists into the various components of PHC.</p><p><strong>Methods: </strong>A scoping review was conducted in 2024 reviewing the evidence published between 2000 and 2024. For such purpose, multiple databases were searched including PubMed, Scopus, ProQuest, Web of Science, and the Google Scholar.</p><p><strong>Results: </strong>A total of 90 studies were found to be eligible for inclusion. The study identified key challenges to pharmacists' integration in PHC across 6 areas: governance issues such as lack of trust and regulatory barriers; financial constraints and payment problems; workforce shortages and inadequate training; infrastructure and technology limitations; restricted access to health information; and service delivery problems including poor collaboration and fragmented care.</p><p><strong>Conclusions: </strong>The study provided several barriers to pharmacists integration in PHC. In such context, the study proposed policymakers to fund sustainably, strengthen infrastructure, enact supportive policies, and promote collaboration, coordination, and expanded pharmacist roles.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251371825"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting Cardiovascular Risk Factor Management in Primary Care Clinics: The Relationship Between External Linkages and Organizational Change Preparedness.","authors":"Larry R Hearld, Demetria Hubbard, Kimberly A Smith, Sharon Parker, Elizabeth A Jackson, Andrea Cherrington","doi":"10.1177/21501319251356551","DOIUrl":"10.1177/21501319251356551","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Primary care organizations increasingly face pressures to implement evidence-based practices that can support patient-centered goals. Foundational to these implementation efforts is how prepared the organization is to change. The purpose of this study was to examine whether different types of external linkages among 47 primary care practices participating in a statewide, community-academic partnership/cooperative focused on improving cardiovascular health outcomes were associated with greater change preparedness. Relatively little research has examined these linkages among smaller primary care practices in the U.S. and the extent to which they may support or hinder efforts to adopt innovative, evidence-based practices.</p><p><strong>Methods: </strong>The study adopted a non-randomized, pre-post design with primary care clinics as the unit of observation. Cross-sectional regression analysis of data collected via surveys administered in 2022 to 2023. Our dependent variables included 2 summated scales related to change readiness (change commitment and change efficacy) and 1 summated scale related to change process capacity, while controlling for differences in clinic characteristics and community characteristics.</p><p><strong>Results: </strong>Clinics that were part of a network (structural linkage) were associated with lower levels of change commitment (<i>b</i> = -1.36, <i>P</i> = .006) and change efficacy (<i>b</i> = -1.16, <i>P</i> = .021). The other 2 types of external linkages (informational and consumer/patient) were not significantly associated with either change commitment or change efficacy.</p><p><strong>Conclusions: </strong>Study clinics exhibited relatively high levels of change preparedness, providing a solid foundation for efforts to reduce cardiovascular risks in critical primary care settings. However, primary care clinics that were linked structurally were associated with lower levels of change preparedness. Primary care leaders and policy makers may want to consider the relationships between primary care clinics and other entities in their environment when developing and implementing programs to reduce cardiovascular disease risks in these settings.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251356551"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional, Cognitive, and Functional Deficits, Frailty, and Quality of Life Associated With Fall Risk in Community-Dwelling Older Adults: A Cross-Sectional Study Conducted in Brazil.","authors":"Larissa Amorim Almeida, Bruno Araújo da Silva Dantas, Kalyne Patrícia de Macêdo Rocha, Mayara Priscilla Dantas Araújo, Nathaly da Luz Andrade, Francisco de Assis Moura Batista, Railson Luís Dos Santos Silva, Monara Lorena Medeiros Silvino, Lívia Batista da Silva Fernandes Barbosa, Matheus Medeiros de Oliveira, Thaiza Teixeira Xavier Nobre, Rafaela Carolini de Oliveira Távora, Adriana Catarina de Souza Oliveira, Gilson de Vasconcelos Torres","doi":"10.1177/21501319251341742","DOIUrl":"10.1177/21501319251341742","url":null,"abstract":"<p><strong>Introduction/objective: </strong>Falls affect approximately 30% of the older adult population. We aimed to compare the associations between fall risk and different multidimensional health aspects among older adults receiving care in the Brazilian Primary Health Care (PHC) system.</p><p><strong>Method: </strong>Cross-sectional, quantitative study involving older adults from PHC. The Fall Risk Score, Mini Nutritional Assessment, Mini-Mental State Examination, Edmonton Frail Scale, Barthel Index, Lawton & Brody Scale, and Medical Outcomes Study Questionnaire Short Form was used to measure the variables of interest. Correlation analyses and binary logistic regression were also employed.</p><p><strong>Results: </strong>A total of n = 257 individuals participated, of whom n = 102 (39.7%) were with risk for falls. Preserved cognition, absence of frailty, and better functionality levels were identified as protective factors against fall risk through association and correlation analyses. The binary logistic regression analysis found that the factors contributing most to the reduction of fall risk were higher nutritional scores, better cognitive function, preserved functionality (BADL and IADL), and the functional domain of quality of life (QoL).</p><p><strong>Conclusion: </strong>Better nutritional status, cognition, functionality, and QoL were associated with a lower risk of falls. Although frailty exhibited similar results, it did not stand out equally as a contributing factor to fall risk.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251341742"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Pharmacists and Collaborative Practice Agreements to Treat Hepatitis C: A Survey of Primary Care Clinicians in Washington State.","authors":"Jocelyn R James, Emalie Huriaux, Jon Stockton, Allison Cole, Judith I Tsui","doi":"10.1177/21501319251359547","DOIUrl":"10.1177/21501319251359547","url":null,"abstract":"<p><strong>Background: </strong>Collaborative care models that utilize pharmacists can expand hepatitis C (HCV) treatment access, but little is known about primary care provider (PCP) views on such models of care. We characterized PCP experiences of HCV treatment and assessed acceptability of leveraging pharmacists to treat HCV.</p><p><strong>Methods: </strong>We surveyed a convenience sample of Washington (WA) State PCPs regarding HCV treatment, experience of collaborating with pharmacists, and comfort with pharmacists managing HCV care. We report summarized descriptive statistics of survey responses.</p><p><strong>Results: </strong>Seventy-three PCPs completed the survey, 55% of whom prescribe buprenorphine for opioid use disorder. Nineteen percent directly treat HCV. Forty-five percent were aware of collaborative practice agreements (CPAs) and 22% reported interest in establishing a CPA to treat HCV. Most respondents were comfortable or extremely comfortable with pharmacists managing key elements of HCV care.</p><p><strong>Conclusions: </strong>In a sample of WA State PCPs, of whom greater than half prescribe buprenorphine for OUD, fewer than 1 in 5 directly treat HCV. Comfort with pharmacists managing most components of HCV treatment was high, but a minority of PCPs were familiar with or interested in establishing CPAs. Additional efforts are needed to leverage pharmacists to treat HCV, including among people who use drugs.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251359547"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of Site-Specific Hepatitis C Virus Treatment Workflows for Vulnerable, High-Risk Populations: A Prospective Single-Arm Trial.","authors":"Anmol Desai, Kia Reinis, Lauren O'Neal, Patrick Chang, Cristal Brown, Michael Stefanowicz, Audrey Kuang, Deepak Agrawal, Tim Mercer, Darlene Bhavnani","doi":"10.1177/21501319251330622","DOIUrl":"10.1177/21501319251330622","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatitis C virus (HCV) treatment with pan-genotypic direct acting antivirals is highly effective, given an evidence-based simplified treatment algorithm. Yet access to treatment is limited among vulnerable populations.</p><p><strong>Objective: </strong>We assessed the effectiveness of site-specific HCV treatment workflows on HCV care for vulnerable populations in Austin, Texas.</p><p><strong>Methods: </strong>Patients diagnosed with chronic hepatitis C enrolled in care at a study site were eligible for this prospective, single-arm clinical trial. We assessed the proportion of participants that: (1) were prescribed treatment, (2) initiated treatment, (3) completed treatment, (4) were assessed for cure, and (5) achieved cure. We also evaluated implementation using the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework.</p><p><strong>Results: </strong>Of 62 participants, 89% had ever experienced homelessness and 94% had ever used drugs. An estimated 66% (95% CrI, 42%-84%) were prescribed treatment and 49% (95% CrI, 26%-70%) initiated treatment. An estimated 38% (95% CrI, 20%-58%) completed treatment, 14% (95% CrI, 4%-44%) were assessed for cure, and 10% (95% CrI, 2%-35%) achieved cure.</p><p><strong>Conclusions: </strong>We identified gaps along the HCV care cascade between: (1) enrolled to prescribed treatment and (2) completed treatment to assessed for cure. Site-specific HCV treatment workflows were insufficient to engage participants in care and avoid treatment delays. Novel approaches are needed and these may include patient outreach, patient navigation, test-and-treat protocols, and removing financial or payor barriers to medication access.</p><p><strong>Trial registration: </strong>Registered on ClinicalTrials.gov on July, 14, 2022. Identifier: NCT05460130. https://clinicaltrials.gov/ct2/show/NCT05460130.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251330622"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Chronological Age: Active Ageing Index, Social Class, and Economic Realities of Rural Karnataka, India.","authors":"Archana Mandal, Mangala Subramanian","doi":"10.1177/21501319251380672","DOIUrl":"10.1177/21501319251380672","url":null,"abstract":"<p><strong>Background: </strong>The country's ageing population, particularly in rural areas, presents growing public health and policy challenges. Gender-based disparities in socioeconomic domains further exacerbate vulnerabilities among the elderly. Assessing ageing through domains that incorporate local factors is essential for designing effective interventions.</p><p><strong>Objectives: </strong>This study aimed to: (1) assess active ageing levels among rural older adults using a locally adapted Active Ageing Index (AAI) aligned with the WHO framework; (2) examine the association between AAI scores and sociodemographic factors, including age, gender, marital status, education, employment, and social class; and (3) explore gender-based disparities in economic and social security indicators-such as land ownership, income sufficiency, and pension access-that influence active ageing through secondary analysis.</p><p><strong>Methods: </strong>A community-based cross-sectional study was conducted among 355 older adults in rural study area. The AAI was constructed using domain-based indicators across health, participation, and security, and categorised into Poor, Moderate, and Good levels. Associations with sociodemographic variables were assessed using Chi-square tests. For the third objective, gender differences in economic and security-related indicators were assessed through secondary analysis involving cross-tabulations and chi-square tests.</p><p><strong>Results: </strong>Among the participants, 53.5% had Good AAI scores, 40.3% Moderate, and 6.2% Poor. A significant association was observed between AAI and social class (χ² = 7.02, <i>p</i> = .0306). Gender was not significantly associated with overall AAI categories; however, Secondary analysis of economic indicators within the Security domain revealed that women had lower land ownership, pension access, and income sufficiency compared to men.</p><p><strong>Conclusion: </strong>Active Ageing Index was significantly associated with social class. While overall AAI scores did not differ significantly by gender, domain-level analysis demonstrated that socio-economic disadvantages place elderly women at greater risk of security. These results underscore the importance of gender-sensitive policies and interventions to strengthen the Security pillar of active ageing in rural India, ensuring equitable opportunities for all older adults.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251380672"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Driving Sustainability in Asthma and COPD Management: Preventative Models and Green Prescribing in a Rural Primary Care Practice in England.","authors":"Meredith Donaldson, Carl Deaney","doi":"10.1177/21501319251334217","DOIUrl":"https://doi.org/10.1177/21501319251334217","url":null,"abstract":"<p><strong>Background: </strong>Asthma and COPD are among the most prevalent chronic respiratory conditions, with inhalers as their primary pharmacological treatment. In the UK, metered-dose inhalers (MDIs) account for 70% of all inhaler prescriptions and contribute significantly to the NHS's carbon footprint, making green prescribing a critical focus. Aligning environmental sustainability with clinical excellence is essential to reducing exacerbations and deaths while minimising carbon emissions.</p><p><strong>Objective: </strong>This initiative aimed to assess the localised impact of a structured quality improvement program designed to enhance respiratory care and integrate sustainable prescribing practices. Specifically, it sought to evaluate prescribing patterns, respiratory review completion rates, and the feasibility of transitioning patients from MDIs to lower-carbon alternatives whilst maintaining clinical outcomes.</p><p><strong>Methods: </strong>The initiative, implemented at a UK general practice in January 2020, focussed on staff education, restructuring respiratory consultations, and patient engagement. The \"treatable traits\" paradigm and best practice frameworks guided the program to optimise individualised care. Prescribing data, in-date respiratory review rates, and estimated carbon emissions were analysed over 4 years (2020-2024) using publicly available sources such as OpenPrescribing.net. While education was a component of the intervention, no formal assessment was conducted on its direct impact on prescribing behaviours.</p><p><strong>Results: </strong>The practice achieved an in-date respiratory review rate exceeding 90%, rising to over 96% during the most recent QOF period. Over 4 years, the proportion of non-salbutamol MDI prescriptions decreased from 62.9% to 36.2%, aligning with national sustainability goals. Despite growth in the practice population, overall carbon emissions from inhalers were successfully reduced, reflecting a shift towards lower-carbon prescribing.</p><p><strong>Conclusion: </strong>This initiative illustrates the feasibility of integrating sustainable prescribing practices into routine respiratory care, aligning with the goals of the national health system. This work highlights the potential of local-level interventions to contribute to broader sustainability efforts in respiratory medicine. Improvements in prescribing patterns and review rates have been noted, but more research is needed to evaluate the impact of educational interventions on healthcare providers' and patients' decisions. Future initiatives should focus on structured evaluations of long-term adherence and clinical outcomes.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251334217"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}