The Lancet. Primary care最新文献

{"title":"Models of global primary care post-2030.","authors":"Luke N Allen, Kumanan Rasanathan, Robert Mash, Manuela Villar Uribe, Viviana Martinez-Bianchi, Michael Kidd","doi":"10.1016/j.lanprc.2025.100027","DOIUrl":"10.1016/j.lanprc.2025.100027","url":null,"abstract":"<p><p>Primary care is currently a central focus in global health policy; however, renewed attention has not translated into the investment needed to build systems that are fit for the future. As 2030 approaches, many health systems are converging towards primary care models that provide community-based, first-contact access, but they omit the other core functions of comprehensiveness, continuity, and coordination. In this Viewpoint, we argue that these primary care lite models are ill-equipped to manage the increasing burden of multimorbidity; harness technological disruption; and reduce health inequities. We propose a new trajectory towards hybrid models of care that anchor community-oriented outreach workers within multidisciplinary teams that are trained in family medicine. Although artificial intelligence and digital tools can magnify impact and reach, we warn that their uninformed adoption could create digital gatekeepers and deepen disparities. To future-proof primary care, policy makers should invest in integrated models that deliver robust, equitable, and person-centred care that is needed to meet future challenges.</p>","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"1 3","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12485077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145215482","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":"Estimating inequality in alcohol-related liver disease burden in the UK, 2009 to 2020: a population-based study using routinely collected data.","authors":"Zhaonan Wang, Krishnarajah Nirantharakumar, Arlene Copland, Darren Quelch, Rasiah Thayakaran, Joht Singh Chandan, James Ferguson, Matthew Brookes, Matthew Lewis, Neil Rajoriya, Nigel Trudgill, Ramesh Arasaradnam, Sally Bradberry, Shamil Haroon, Neeraj Bhala, Nicola J Adderley","doi":"10.1016/j.lanprc.2025.100002","DOIUrl":"https://doi.org/10.1016/j.lanprc.2025.100002","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is a need to understand the preventable burden of alcohol-related liver disease (ARLD) and to improve the identification of individuals at high risk. We aimed to establish reliable and stratified epidemiological data to understand the burden of ARLD and the inequalities in this burden related to ethnicity, socioeconomic factors, and region in the UK.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were extracted from Clinical Practice Research Datalink Aurum, a primary care database that includes 20% of UK general practices. The study period was Jan 1, 2009, to Dec 31, 2020; all patients aged 18 years and older registered at a participating practice were eligible for inclusion. Hospital admission data were extracted from linked Hospital Episode Statistics (HES) and ARLD-specific mortality data were obtained from Office for National Statistics Death Registration Data. Several analytical approaches were used, as follows: yearly cross-sectional and cohort analyses to calculate the annual prevalence and incidence of ARLD, respectively; a retrospective, matched, open cohort study to assess all-cause mortality rates (in which patients without liver disease were matched with patients with ARLD on the basis of age, sex, ethnicity, and geographical region); and a retrospective, open cohort analysis to evaluate all-cause hospitalisation rates. Hospitalisation rates were calculated in those with ARLD only. We explored different definitions of ARLD, and our primary definition was definite ARLD (ie, a coded clinical record specifying ARLD). Incidence and prevalence were stratified by age, sex, ethnicity, deprivation (Index of Multiple Deprivation [IMD] quintile) and geographical region.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;During the study period, 19 534 887 patients from 1491 practices were eligible for inclusion in our study. For definite ARLD exposure, 257 544 patients were included in the all-cause mortality outcome analysis, of whom 51 510 were diagnosed with definite ARLD; while among the 50 409 patients with definite ARLD for whom HES-linked data were available, 37 142 had one or more hospital admissions. Prevalence of definite ARLD rose from 154 to 243 per 100 000 population from 2009 to 2020. Incidence increased from 18·6 to 30·3 per 100 000 person-years between 2009 and 2019, and then decreased to 24·7 per 100 000 person-years in 2020. Prevalence and incidence of ARLD by age, sex, ethnicity, geographical region, and IMD quintile increased between 2009 and 2020. The overall adjusted all-cause mortality hazard ratio (HR) for those with definite ARLD compared with no liver disease was 4·30 (95% CI 4·20-4·41). The effect of ARLD on mortality was more pronounced in younger than older age groups (eg, adjusted HR of 21·86 [95% CI 18·23-26·20]) in those aged 30-39 years &lt;i&gt;vs&lt;/i&gt; 2·19 [2·09-2·29] in those ≥70 years) and in females than in males (5·61 [5·35-5·88] &lt;i&gt;vs&lt;/i&gt; 3·93 [3·83-4·04]). The overall incidence rate for hospitalisati","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"1 1","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986766","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":"How major international development organisations operationalise primary health care: a thematic content analysis of strategy documents.","authors":"Luke N Allen, Erica Barbazza, Tova Tampe, Suraya Dalil, Shamsuzzoha Syed, Faraz Khalid","doi":"10.1016/j.lanprc.2025.100014","DOIUrl":"https://doi.org/10.1016/j.lanprc.2025.100014","url":null,"abstract":"<p><p>Despite consensus around the need to prioritise primary health care (PHC), misaligned interpretations of this concept have real-world consequences for implementation. Here, we analysed how 30 major international development organisations operationalise PHC in their corporate strategy documents through thematic content analysis. The findings reveal that despite high-level endorsement for PHC, fewer than half of the reviewed documents explicitly mentioned PHC. Among those that did, PHC was conceptualised in varying ways: as a service delivery platform, level of care, bundle of interventions, or whole-of-society approach to health. From these conceptualisations, three different interpretations of PHC emerged-namely, the intended whole-of-society approach to health, strong or high-quality primary care, and selective or basic primary care. Integral components to PHC, including empowered people and communities and multisectoral action, were largely absent. These findings highlight the opportunities and urgency for improved alignment across international organisations to support a consistent approach aligned with the original vision of PHC.</p>","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"1 1","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986926","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":"Pilot implementation of intermittent preventive treatment with dihydroartemisinin-piperaquine to prevent adverse birth outcomes in Papua, Indonesia: a mixed-method evaluation.","authors":"Firdaus Hafidz, Freis Candrawati, Jenna Hoyt, Enny Kenangalem, James Dodd, Maia Lesosky, Ida Safitri Laksanawati, Reynold Ubra, Minerva Simatupang, Feiko O Ter Kuile, Eve Worrall, Jeanne Rini Poespoprodjo, Jenny Hill","doi":"10.1016/j.lanprc.2025.100011","DOIUrl":"https://doi.org/10.1016/j.lanprc.2025.100011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;A previous trial showed that intermittent preventive treatment with dihydroartemisinin-piperaquine (IPTp-DP) was more effective than the current policy of single screening and treatment in preventing malaria during pregnancy in Papua, Indonesia. The STOPMiP-2 study evaluated the Ministry of Health pilot implementation of IPTp-DP through routine antenatal care in Papua.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A mixed-method evaluation was conducted in ten primary health-care facilities in the Mimika district in Papua, Indonesia from June 8, 2022, to Dec 27, 2023. Pregnant women aged 15-49 years who were HIV negative (when status known), in their second or third trimester of pregnancy, and provided written informed consent were eligible. IPTp-DP delivery effectiveness (3-day doses of three tablets [ie, nine tablets] with the first dose by directly observed therapy during antenatal care) and adherence (completion of all nine tablets, ascertained by pill count) were coprimary outcomes. Analyses were done in the modified intention-to-treat (mITT) population (defined for delivery effectiveness as all women who completed exit interviews, and for treatment adherence as all women who had a home visit). The mITT population excluded women with fever or malaria infection, those with a positive malaria test, or those who received IPTp-DP outside the designated timeframe (ie, less than 4 weeks between courses). We explored predictors of delivery effectiveness and adherence using multivariable logistic regression, and used qualitative data to provide explanatory insights. We used routine health information to assess monthly coverage by facility. This study was registered at ClinicalTrials.gov (NCT05294406) and is now complete.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;From June 8, 2022, to Dec 27, 2023, we enrolled 1420 pregnant women in exit interviews, of whom 1366 had data available and were eligible for the effectiveness analysis. 490 women were visited at home, of whom 484 had data available and were eligible for the adherence analysis. 556 (41%) of 1366 women had effective delivery of IPTp-DP, and among those with available data, 437 (90%) of 484 had full adherence. Predictors of full effective delivery versus partial or non-effective delivery were older maternal age (≥35 years &lt;i&gt;vs&lt;/i&gt; 20-34 years: adjusted odds ratio 1·26 [95% CI 1·04-1·51], p=0·017), having a lower level of education (no education or primary education &lt;i&gt;vs&lt;/i&gt; diploma or university: 2·01 [1·08-3·75], p=0·028), being in the second trimester (&lt;i&gt;vs&lt;/i&gt; third trimester; 3·13 [2·11-4·63], p&lt;0·0001), had previous IPTp-DP (&lt;i&gt;vs&lt;/i&gt; no previous IPTp-DP: 4·30 [3·07-6·01], p&lt;0·0001), and not having health insurance (&lt;i&gt;vs&lt;/i&gt; health insurance: 1·33 [1·09-1·63], p=0·0044). No difference was seen by younger age (age 15-19 years), middle or high school education, ethnicity, marital status, previous malaria test within past 28 days, and location. Predictors of adherence were being","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"1 1","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144987009","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}