Journal of Primary Care and Community Health最新文献

{"title":"Community-Partnered Training in Trauma-Informed Primary Care for Patients Experiencing Reentry From Incarceration: A Pilot Training Study.","authors":"Lauren E Szkodny, Mahlet A Yared, Shoshana H Bardach, Joseph Lascaze, Randy Stevens, Anna M Adachi-Mejia, Milan F Satcher","doi":"10.1177/21501319241312577","DOIUrl":"10.1177/21501319241312577","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Patients returning to the community from incarceration (ie, reentry) are at heightened risk of experiencing trauma when interacting with the healthcare system. Healthcare professionals may not recognize patients' trauma reactions or know how to effectively respond. This paper describes the development and pilot evaluation of a single-session training to prepare primary care teams to deliver trauma-informed care (TIC) to patients experiencing reentry.</p><p><strong>Methods: </strong>A multidisciplinary team including community members with lived experience engaged in a multiphase human-centered design process that incorporated interviews, discussions, and a participatory process to design and evaluate a single-session interactive pilot training targeting providers' attitudes toward formerly incarcerated patients and confidence to deliver TIC.</p><p><strong>Results: </strong>Both pre- and post-training surveys were completed by 12 TIC training attendees, which included primary care providers and staff. Trainees reported significant increases in confidence to reduce potentially re-traumatizing practices and improved attitudes toward formerly incarcerated individuals. They also expressed interest in receiving additional TIC training and learning how best to care for and meet the needs of persons with a history of incarceration. Trainees described the panel of community members with lived experience as one of the most rewarding aspects of the training.</p><p><strong>Conclusion: </strong>Centering people with lived experience in the training design and delivery produced a single-session TIC training that was both well-received and effective. Our TIC training helped primary care providers and staff move from being merely informed on trauma to having the self-efficacy to prevent and respond to trauma reactions during encounters with <i>all</i> patients, particularly those with a history of incarceration.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319241312577"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013922","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":"The Effect of the COVID-19 Pandemic on Prescribing Medications for Opioid Use Disorder in the Mid-Michigan Region.","authors":"Nooshin C Beygui, Erin Duross, Chin-I Cheng, Katherine Mesaros, Karissa Gawronski, Juliette Perzhinsky","doi":"10.1177/21501319251331322","DOIUrl":"10.1177/21501319251331322","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of opioid use coupled with the emergence of the Coronavirus Disease-19 (COVID-19) pandemic impacted opioid overdoses and death rates. People with opioid use disorder (OUD) are particularly vulnerable to the pandemic's consequences. Although Medications for Opioid Use Disorder (MOUD) are the most well supported treatment for OUD, they remain underutilized by clinicians, particularly in the primary care setting, emphasizing the importance of examining factors that impact prescribing.</p><p><strong>Objective: </strong>To assess clinicians' prescribing practices for MOUD and assess the pandemic's effect on MOUD prescription. To determine whether there is an association between patient-specific factors, such as mental health diagnoses and substance use disorder (SUD), and MOUD prescription practices prior to and during the COVID-19 pandemic.</p><p><strong>Methods: </strong>A retrospective chart review assessed 500 patient charts with a diagnosis of OUD to assess demographics, MOUD prescribing, substance use, and co-morbid mental health conditions.</p><p><strong>Results: </strong>312 charts met inclusion criteria. There was no significant difference in the percentage of new MOUD prescriptions among the selected cohort between the 2 selected timeframes, nor was there a significant difference in the prescriber/setting of new prescriptions. Cumulative analysis revealed that greater than 2/3 of the selected patients had concurrent mental health diagnoses. Greater than 50% of patients reported active non-opioid substance use. The odds of having a co-occurring SUD were significantly higher among patients treated in the emergency department and various treatment settings-including urgent care and non-primary care clinics-as compared to the primary care outpatient setting.</p><p><strong>Conclusions: </strong>Strong evidence supports the efficacy of using MOUD in primary care, yet it is underutilized in the mid-Michigan region. Overall prevalence of mental health diagnoses, SUD, MOUD prescriber practices were similar prior to and during the COVID-19 pandemic. There was a high occurrence of co-occurring SUD especially among patients treated outside of the primary care setting. Future initiatives to increase clinician education around MOUD and address patient barriers to treatment are warranted.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251331322"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774603","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 a Multicancer Detection (MCD) Test in a Tertiary Referral Center in Asymptomatic Patients: An 18-Month Prospective Cohort Study.","authors":"Ryan T Hurt, Aditya K Ghosh, Brian M Dougan, Elizabeth A Gilman, Bradley R Salonen, Jay Adusumalli, Sara L Bonnes, Carl A Andersen, Amirala S Pasha, Sanjeev Nanda, Erin M Pagel, Christina D Verness, Steven D Crowley, Steven W Ressler, Jewel J Samadder, Richard J Presutti, Aadel A Chaudhuri, William Sanchez, Ivana T Croghan, Christopher R Stephenson, Karthik Ghosh","doi":"10.1177/21501319251329290","DOIUrl":"10.1177/21501319251329290","url":null,"abstract":"<p><strong>Objective: </strong>Multicancer Detection (MCD) tests, such as the GRAIL Galleri, offer a novel approach to cancer screening by detecting cancer-specific methylation patterns in cell-free DNA through a single blood sample. This study evaluated an 18-month implementation of MCD testing in a tertiary ambulatory internal medicine clinic.</p><p><strong>Patients and methods: </strong>Between June 2022 and November 2023, 2244 asymptomatic (without symptoms attributed to cancer) patients underwent MCD testing. The study focused on operational workflows, patient and physician education, and diagnostic follow-up of positive results. Standardized materials, including electronic health record (EHR) workflows, FAQs, and diagnostic pathways, were developed to facilitate implementation. Challenges included managing false positives, patient anxiety, costs, and ethical considerations.</p><p><strong>Results: </strong>Of the 2244 patients tested, 17 (0.76%) had positive results, and 15 underwent further diagnostic evaluation. Cancer was confirmed in 11 (73.3%) patients, including cases of breast, colon, esophageal, lymphoma, ovarian, and pancreatic cancers. Four patients had no identifiable malignancy despite comprehensive work-up.</p><p><strong>Conclusions: </strong>MCD testing is feasible in routine clinical workflows, with 73% of positive cases yielding cancer diagnoses. While promising, further research is required to assess long-term outcomes, cost-effectiveness, and optimal implementation strategies of cancer interception in broader healthcare settings.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251329290"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711582","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":"Readmission After Geriatric Inpatient Care: A Narrative Review and a Comparative Analysis.","authors":"Carl Willers, Rikard Lindqvist, Martin Dreilich, Stefan Fors, Amelie Lindh Mazya, Gunnar H Nilsson, Anne-Marie Boström, Mahwish Naseer, Elisabeth Rydwik","doi":"10.1177/21501319251320181","DOIUrl":"10.1177/21501319251320181","url":null,"abstract":"<p><strong>Background: </strong>Readmission can be be related to the work of several stakeholders involved in the care of individuals throughout the community, including, for example, primary care and social care providers. A narrative review was performed to assess definitions and frequency of readmission for older adults found in previous research. In addition, a dataset for a cohort of older adults in Stockholm, Sweden, was used to quantify how different definitions of readmission affect frequency.</p><p><strong>Materials and methods: </strong>The review was based on pre-specified search criteria within PubMed and Embase databases. All studies based on a cohort of older adults with a primary objective to assess readmission to inpatient care, were included for the assessment of readmission criteria. The dataset was based on a cohort of older adults treated at a geriatric department in Stockholm during 2016. Estimations of readmission were performed with the most common criteria found in the narrative review.</p><p><strong>Results: </strong>The narrative review showed that definitions of readmission included predominantly time-based criteria, either alone or combined with additional criteria such as medical condition or readmitting department. Frequency of readmission based on different definitions varied substantially; a 14-day time interval implied a rate of 8.0% whilst a 30-day interval-more commonly used-rendered a rate of 12.6%. The density of readmissions per day was higher during the first weeks after discharge, and then dropped continuously.</p><p><strong>Conclusion: </strong>Transparency on definitions is imperative in studies that include rates of readmission. The levels of readmission rates are highly dependent on the study population and its context. Furthermore, the actual value of readmission monitoring is dependent on what purpose it is supposed to fulfill, and it is essential to put it into context of all relevant stakeholders including, for example, the primary care providers and different social care providers throughout the community.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251320181"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524802","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":"Compliance and Performance of Hand Hygiene in Dutch General Practice Offices Using Electronic Dispensers.","authors":"Nataliya Hilt, Matthijs S Berends, Mariëtte Lokate, Bert Tent, Andreas Voss","doi":"10.1177/21501319251334218","DOIUrl":"https://doi.org/10.1177/21501319251334218","url":null,"abstract":"<p><strong>Introduction: </strong>One of the most effective measures for the reduction and prevention of healthcare-associated infections (HAI) is hand hygiene (HH). Covert direct observation of HH is difficult to realize in general practice office (GPO). The World Health Organization recognizes electronic monitoring as a form of measuring product use and estimating compliance. This is the first study to monitor HH performance electronically in Dutch GPOs.</p><p><strong>Objectives: </strong>The main aim of this study was to evaluate HH compliance in general practice offices.</p><p><strong>Methods: </strong>An observational study was conducted at 4 Dutch GPOs between 2019 and 2021. We measured HH compliance using data on HH events (HHE) from alcohol-based hand rub (ABHR) dispensers with a built-in electronic counter. Daily HH opportunities were calculated according to the 'Five Moments for Hand Hygiene' based on the continuously documented activities using general practitioners (GPs) patient electronic dossier systems.</p><p><strong>Results: </strong>In total, hand hygiene was performed during 1786 of the estimated 4322 opportunities (41%). HH compliance for the general practitioners, practice assistants, and nurse practitioners was 38%, 51%, and 43%, respectively. The overall HH compliance within the same GPOs was 42% pre-pandemic and rose to 56% during the pandemic. The overall mean volume of ABHR was 2.44 ml, varying per HHE between 1.91 to 2.55 ml. The mean volume of ABHR measured before and during the pandemic rose from 2.55 ml to 2.81 ml. The overall self-reported compliance was 86% and was highest among nurse practitioners.</p><p><strong>Conclusions: </strong>Hand hygiene compliance among HCWs in Dutch GPOs was found to be 41%, with general practitioners having the lowest compliance and practice assistants the highest compliance. While the mean volume of ABHR used per HHE seems appropriate, directed observations would be needed to ensure that an adequate hand-rub technique was used to cover the whole hand. Multi-modal interventions are needed to improve HH-compliance and stimulate the switch to ABHR with in the Dutch general practice office.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251334218"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015292","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":"Evaluating the Impact of the Medication Therapy Management Program on Patients' Blood Pressure and Obesity: A Pre-Post Study.","authors":"Hossein Zare, Augustine C Amuta, Magaly Rodriguez de Bittner, Sade Osotimehin, Laurine Thomas, Twarnisha M Stokes, Amber Allen, Jacob Riley, Caitlin L Murphy, Debra M Collier, Roland J Thorpe, Michelle Spencer, Lois Dankwa, Ernest L Carter, Darrell J Gaskin","doi":"10.1177/21501319251332721","DOIUrl":"https://doi.org/10.1177/21501319251332721","url":null,"abstract":"<p><strong>Background: </strong>Hypertension and obesity are major public health problems in the United States and Maryland.</p><p><strong>Objectives: </strong>To assess the impact of Medication Therapy Management (MTM) on controlling hypertension and obesity in a sample in Southern Maryland: Prince George's, Calvert, Charles, and St. Mary's counties.</p><p><strong>Methods: </strong>171 patients with high blood pressure were enrolled in an MTM program for 12 months. Patients received at least one pharmacist consultation between September 2021 and September 2023. We employed a pre-post prospective study design to assess the impact of MTM on patients' blood pressure management. We examined the association between MTM and systolic blood pressure (SBP) and diastolic BP (DBP) as the primary outcome, and weight and body mass index (BMI) as secondary outcomes. We used descriptive analysis and fixed effect regression models to present the association between outcome variables and enrollment time in the program.</p><p><strong>Results: </strong>Our findings showed that the MTM reduced uncontrolled hypertension by 17.5 percentage points, weight by 3.6lbs (10.2), and BMI by 0.6 kg/m² (2.1). The regression model showed that the MTM intervention reduced the prevalence of uncontrolled hypertension (-1.81, CI: [-3.11, -0.51]), and obesity (BMI > 30, -1.85 (CI: [-3.12, -0.57]), by 12 months of enrolling in the program. During this time SBP reduced to -10.37 mmHg (CI: [-19.62, 1.2]).</p><p><strong>Conclusions: </strong>Our results suggest that policymakers should prioritize promoting MTM services as an effective means of blood pressure control. Combining a community health worker (CHW) model with community-based pharmacists can further improve health outcomes for patients with hypertension.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251332721"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006428","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":"A New Model of Care: Community Appointment Day Outcomes and Impact on Musculoskeletal Physiotherapy Waiting Times.","authors":"Helen Alexander, Alan Sinclair, Laura Dover, Brian Slattery, Ruth Currie, Mark Russell, Judith Cain","doi":"10.1177/21501319251334036","DOIUrl":"https://doi.org/10.1177/21501319251334036","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to test the introduction of Community Appointment Days (CADs) for patients on the Musculoskeletal (MSK) Physiotherapy waiting list in Lanarkshire, UK.</p><p><strong>Methods: </strong>A multi-professional team developed, implemented, and evaluated the first 2 CADs on 16th and 17th April, 2024. The mixed-methods design involved patients completing a \"passport\" (which included a survey) on the day and being followed up 4 weeks later by survey or interview. The patient management system was interrogated for waiting times and numbers returning to the service within 6 months. Structured thematic analysis was used to create a conceptual model from the qualitative data.</p><p><strong>Results: </strong>More than 3 times as many patients were booked into a CAD appointment (n = 443) compared to routine outpatient clinics (n = 133), and the vast majority reported positive outcomes. A total of 52 attendees (12%) were discharged on the day and a further 202 (46%) with Patient Initiated Review (PIR). Only 126 (28%) were given a follow-up 1:1 Physiotherapy appointment, although 63 (14%) did not attend on the day. Of the 443 booked, 26 (6%) returned for an additional review MSK outpatient appointment within 6 months.</p><p><strong>Conclusions: </strong>The CADs had positive outcomes for patients and were successful in reducing waiting times.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251334036"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987950","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":"The 5 A's Approach to Promoting Nutrition Counseling in Primary Care.","authors":"Farhad Mehrtash, JoAnn E Manson","doi":"10.1177/21501319251338566","DOIUrl":"10.1177/21501319251338566","url":null,"abstract":"<p><p>Poor dietary habits are a major contributor to chronic disease burden, yet nutrition counseling remains underutilized in primary care settings despite proven effectiveness. This article presents a novel adaptation of the 5 A's framework (Assess, Advise, Agree, Assist, Arrange) titled 'The 5 A's Approach to Promoting Nutrition Counseling in Primary Care', by incorporating validated assessment tools and evidence-based strategies to support implementation in clinical settings. To address practical challenges, implementation approaches are proposed including alternative delivery and payment models. The 5 A's adaptation can be a tool used to address the critical need for standardized nutrition counseling in primary care.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251338566"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129134","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":"Gender and Health in Asia: Toward Gender-Affirming Care in the ASEAN Region.","authors":"Rowalt Alibudbud","doi":"10.1177/21501319251316667","DOIUrl":"10.1177/21501319251316667","url":null,"abstract":"","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251316667"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061096","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":"Integrating Ambulatory Care Pharmacists Into Value-Based Primary Care: A Scalable Solution to Chronic Disease.","authors":"Alexander J Blood, Harry Saag, Adam Chesler, Dalia Ameripour, Max Gutierrez, Van Nguyen, Cassandra Richardson, Clive Fields, Jen Clair, Aaron Yao, Sashi Moodley","doi":"10.1177/21501319241312041","DOIUrl":"10.1177/21501319241312041","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Patients living with chronic diseases require more medical attention, including more visits to primary care. However, primary care providers are overburdened, and this specialty is attracting fewer new providers than before. Clinical pharmacists can augment these efforts by improving disease state control. In this cohort study, we aimed to demonstrate a retail pharmacy hired and trained clinical pharmacist within a value-based primary care clinic network can improve hypertension (HTN) and type 2 diabetes mellitus (T2DM) control.</p><p><strong>Methods: </strong>In this cohort study, a pharmacist, enabled by a collaborative drug therapy management agreement, prescribed and titrated therapies for HTN and T2DM. Primary outcomes were pre- to post-index changes in hemoglobinA1c, systolic, and diastolic blood pressure (BP) measures.</p><p><strong>Results: </strong>The HTN cohort consisted of 43 patients and the T2DM cohort consisted of 125 patients. The difference-in-differences (β) in the HTN group was -10.2 mmHg (<i>P</i> < .01) for systolic BP and -2.0 mmHg (<i>P</i> = .42) for diastolic BP. The β in the T2DM group was -1.16% (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>Statistically significant reductions in systolic BP and hemoglobinA1c were observed in the pharmacist-managed group compared with matched controls. These results demonstrate that pharmacist integration into a value based primary care clinic may improve measures of chronic disease associated with morbidity and mortality.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319241312041"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11713977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956814","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}