The Lancet. Primary care最新文献

{"title":"SMS text message reminders versus usual care for cervical screening attendance in London, UK: a retrospective secondary analysis of routinely collected data.","authors":"Beth Nichol, Josephine Ruwende, Jeff Powell Davies, Kaloyan Haralampiev, Christian Von Wagner, Aikaterini Grimani, Luke Vale, Ivo Vlaev","doi":"10.1016/j.lanprc.2026.100215","DOIUrl":"https://doi.org/10.1016/j.lanprc.2026.100215","url":null,"abstract":"<p><strong>Background: </strong>Previous randomised controlled trials have shown that general practitioner (GP)-endorsed text message reminders can increase cervical screening attendance. Following the implementation of these reminders across routine primary care services in London (UK), we aimed to assess their effect on likelihood of cervical screening attendance when implemented at scale.</p><p><strong>Methods: </strong>In this retrospective secondary analysis of routinely collected data, all individuals aged 24-64 years who were eligible for cervical screening within participating GP practices in London between June 21, 2021, and March 11, 2024, were included. People who had opted out of the screening programme or the text reminder service, had had a cervical screening before the initial invitation letter, or were out of the age range at the time of the initial invitation letter (ie, aged <24 years or ≥65 years) were excluded. Attendance was compared between individuals who received a GP-endorsed SMS reminder and those who did not. The main outcome was odds of cervical screening attendance within the screening cycle. Routinely collected data were obtained from the text message provider and the National Health Application and Infrastructure Services (now the UK National Health Service Cervical Screening Management System). We used binary logistic regression to examine associations between SMS reminder delivery and attendance, adjusting for previous screening behaviour, age, and deprivation. Data on sex, gender, and ethnicity were not possible to include.</p><p><strong>Findings: </strong>Of the 3 530 557 individuals assessed for eligibility, 3 127 759 were included and 402 798 were excluded. 2 112 003 (67·5%) of the 3 127 759 individuals received an SMS reminder for cervical screening and 1 015 756 (32·5%) did not. 1 091 902 (51·7%) of the 2 112 003 individuals who received an SMS reminder attended a screening, which was an increase of 1·7 percentage points since the last screening cycle (1 055 287 [50·0%] of 2 112 003), whereas 253 556 (25·0%) of 1 015 756 individuals who did not receive an SMS reminder attended a screening, which was a decrease of 2·8 percentage points since the last screening cycle (282 484 [27·8%] of 1 015 756). Successful delivery of an SMS reminder resulted in an increased likelihood of cervical screening attendance (odds ratio 3·36 [95% CI 3·31-3·40]; p<0·0001).</p><p><strong>Interpretation: </strong>The findings indicate the potential effect of SMS reminders as a scalable component of cervical screening systems while emphasising the importance of digital reach, contact-data quality, and equitable implementation. Further research should evaluate differential effects considering demographic characteristics, including ethnicity and socioeconomic status.</p><p><strong>Funding: </strong>National Institute for Health and Care Research and the National Recovery and Resilience Plan of the Republic of Bulgaria.</p>","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"2 9","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198470","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":"Refinement of a scoping tool to tackle antimicrobial resistance via a primary health care approach: insights from Kazakhstan, Sweden, and Thailand.","authors":"Serena W Y Chong, Sarah Paulin, Faraz Khalid, Stephan Stenmark, Danilo Lo Fo Wong, Deborah Tong, Ketevan Kandelaki, Viroj Tangcharoensathien, Bassem Zayed, Abzal Zhumagaliuly, Erica Barbazza, Shamsuzzoha B Syed, Nienke Bruinsma","doi":"10.1016/j.lanprc.2026.100211","DOIUrl":"10.1016/j.lanprc.2026.100211","url":null,"abstract":"<p><p>WHO recommends a primary health care (PHC)-oriented health system for delivering high-quality, equitable, and efficient care in all countries. Primary care and the community serve as the frontlines for preventing and managing infections and addressing the rise of antimicrobial resistance (AMR). WHO developed a scoping tool to identify AMR-relevant interventions that can be used to strengthen PHC-oriented health systems and applied it to country reviews in Kazakhstan, Sweden, and Thailand. The objective was to identify AMR interventions in primary care and the community that are context relevant, improve quality of care, and strengthen health systems. These interventions included the integration of AMR-related efforts, antimicrobial stewardship, and infection prevention and control into health system policies, practice, and governance; promotion of appropriate antimicrobial use, including use of routine health data; stronger pre-service education and in-service training and support for the primary care workforce; and ensuring access to essential medicines while enforcing regulations on non-prescription sales of antibiotics. Foundational elements of health systems such as water, sanitation, and hygiene and immunisation programmes were also essential for a comprehensive AMR response. This process highlighted the need to engage with a diverse range of stakeholders and to consider social and contextual differences when designing AMR-relevant interventions. National AMR programmes should collaborate with health-system planners to integrate AMR-related interventions into PHC-oriented health systems, strengthening them to drive progress in countries towards universal health coverage while achieving global targets on AMR.</p>","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"2 9","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130225","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 digital intervention to protect cognitive health in older adults with cognitive impairment: a three-arm, open-label, randomised controlled trial.","authors":"Paul Little, Rosie Essery, Jane Somerville, Taeko Becque, Victoria Hayter, Beth Stuart, Katherine Bradbury, Gareth Griffiths, Simon Griffin, Tony Kendrick, Nanette Mutrie, Sian Robinson, Louise Robinson, Guiqing Yao, Shihua Zhu, Sebastien Pollet, James Denison-Day, Helen Brooker, Anne Corbett, Paul Lee, Shanaya Rathod, Bernard Gudgin, Rosemary Phillips, Tom Stokes, John Niven, Angela McCullagh, Sara McCloskey, Martin Rossor, John Gallacher, John O'Brien, Clive Ballard, Lucy Yardley","doi":"10.1016/j.lanprc.2026.100192","DOIUrl":"10.1016/j.lanprc.2026.100192","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cognitive impairment affects health and social care. Intensive multicomponent interventions work but are impractical for primary care. The study aimed to trial brief approaches for cognitive health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was an open-label trial among adults aged 60-85 years with internet access and low cognitive scores (SD ≥1 below normal on the Baddeley verbal reasoning test, the cognitive criteria for age-associated-cognitive decline [AACD]). We used computer-generated random numbers to allocate participants to one of three groups: (1) Active Brains website (supporting physical activity, a Mediterranean diet, and cognitive exercises); (2) Active Brains plus brief support (three email or telephone sessions); or (3) control (evidence-based advice for cognitive health). The primary outcome was Baddeley verbal reasoning score at 12 months analysed by intention-to-treat with multiple imputation for missing data; follow-up for a co-primary outcome of dementia at 5 years is ongoing. The key secondary outcome was to describe the clinically important cutpoints of the Baddeley test. The trial is registered with International Standard Randomised Controlled Trial (ISRCTN17349359), is closed to new participants, and follow-up is ongoing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Between Oct 3, 2020, and Oct 30, 2023, 11 563 participants from 670 practices were randomly assigned to either the active brains group (n=3169), active brains plus support (n=3087), or control (n=3927; intention-to-treat population). Participants were predominantly White (11 087 [95·8%]), 6697 (57·9%) were female, and 8142 (70·4%) were retired. Recruitment and 12-month follow-up (median 366 days in all groups) are complete. Baseline mean Baddeley verbal reasoning score was 15·1 (SD 6·4) in the control group, 15·3 (6·2) in the Active Brains group, and 15·1 (6·4) in the Active Brains plus support group. 12-month data were available for the primary outcome for 3113 (79·3%) of 3927 participants in the control group, 2564 (67·3%) of 3810 in the Active Brains group, and 2566 (67·1%) of 3826 in the Active Brains plus support group. At 12 months, mean Baddeley verbal reasoning score was 18·3 (SE 0·14) in the control group, 18·7 (SE 0·16) in the Active Brains group (adjusted mean difference &lt;i&gt;vs&lt;/i&gt; control +0·50, 95% CI 0·13-0·87), and 19·2 (SE 0·16) in the Active Brains plus support group (+0·97, 0·59-1·34). This resulted in a substantial minority in all groups no longer meeting the cognitive criteria for AACD (883 [28·4%] of 3113 in the control group; 842 [32·8%] of 2566 in the Active Brains group; 811 [31·6%] of 2546 in the Active Brains plus support group), and fewer in the Active Brains plus support group (but not the Active Brains group) met cognitive criteria for mild or severe cognitive impairment. Serious adverse events and deaths, all unrelated to treatment, were similar in all groups. Serious adverse events occurred in 33 (0·87%) of 3810 in ","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"2 8","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148915135","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":"Weight status and pathways to eating disorder referral from primary care in England and Northern Ireland: a cross-sectional analysis of routine care data.","authors":"Chloe Gao, Jessica Wilkins, Alex Dregan, Karina L Allen, Jamie Scuffell, Ulrike Schmidt","doi":"10.1016/j.lanprc.2026.100179","DOIUrl":"10.1016/j.lanprc.2026.100179","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is a need to understand how weight status influences access to eating disorder services. We aimed to examine characteristics of adults with eating disorder diagnoses in primary care settings in England and Northern Ireland and to assess the association between weight status and referral to specialist eating disorder services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a cross-sectional analysis of electronic health records from Clinical Practice Research Datalink (CPRD) Aurum, which includes general practices in England and Northern Ireland, with an observation period of Jan 1, 2010, to Dec 31, 2023. We included people aged 18-80 years with at least one eating disorder diagnosis with or without an eating disorder referral, and excluded people with only an eating disorder referral without an eating disorder diagnosis. All data were extracted from CPRD Aurum except Index of Multiple Deprivation, which was extracted from the UK Office of National Statistics. To examine the association between the primary exposure of weight status (ie, with underweight &lt;i&gt;vs&lt;/i&gt; without underweight) and the main outcome of eating disorder referrals from primary care, we conducted six sets of generalised estimating equation models accounting for practice-level clustering. All primary models were done with a complete-case analysis, with participants excluded if data were missing for any included variables. To explore potential multiplicative effects of the two exposure variables, weight status and eating disorder diagnostic category, on our outcome variable of eating disorder referral, we included an interaction term between weight and eating disorder diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;35 404 people with at least one eating disorder diagnosis aged 18-80 years were included in our analysis, of whom 26 822 (75·8%) did not receive an eating disorder referral. Most people identified as White (29 545 [83·5%] of 35 404), followed by Asian (2154 [6·1%]), unknown (1325 [3·7%]), Black (1028 [2·9%]), mixed/multiple (682 [1·9%]), and other (110 [0·3%]). There were 28 944 (81·8%) female individuals and 6460 (18·2%) male individuals. The interaction term between anorexia nervosa diagnosis and underweight was positively associated with receiving an eating disorder referral (odds ratio 4·05 [95% CI 3·54-4·63]; p&lt;0·0001). The interaction term between having an avoidant restrictive food intake disorder diagnosis and underweight was not statistically significant (0·84 [0·53-1·32]; p=0·54). Similarly, the interaction term between having a binge eating disorder diagnosis and underweight was not statistically significant (0·62 [0·10-3·88]; p=0·61). The interaction terms between having an eating disorder diagnosis and underweight for bulimia nervosa (0·76 [0·64-0·90]; p=0·0018), other specified feeding or eating disorder (0·76 [0·64-0·90]; p=0·0018), and generic eating disorder (0·72 [0·65-0·80]; p&lt;0·0001) were negatively associated with rece","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"2 7","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727581","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 general practice workforce crisis in Europe: scale of the challenge and available policy responses.","authors":"Giuliano Russo, Martin McKee, Tomas Zapata, Alba Llop Girones, Sulakshana Nandi, Sara Ares-Blanco","doi":"10.1016/j.lanprc.2026.100166","DOIUrl":"10.1016/j.lanprc.2026.100166","url":null,"abstract":"<p><p>General practice across the European region faces a systemic workforce crisis that threatens patient access to health services as well as the coordination, continuity, and equity of care within European health systems. In this Health Policy paper, we use an analysis of the WHO/Europe-Eurostat-Organisation for Economic Co-operation and Development (OECD) Joint Questionnaire on Non-Monetary Health Care Statistics dataset for 43 countries, evidence from a dedicated research collection, and a rapid review of policy interventions to assess the scale, drivers, and solutions to general practitioner (GP) shortages. Although headcounts have increased since 2010, GP density has stagnated, and effective full-time equivalent capacity has declined due to ageing, early retirement, part-time work, migration, administrative burden, and private-sector competition. We argue that incremental responses are insufficient and propose a coordinated, lifecycle-based strategy spanning training, recruitment, retention, and late-career roles. Key actions include expanded training pathways, improved employment conditions, rural and return-migration incentives, expanded multidisciplinary teams, reduced administrative workload, and full-time equivalent-sensitive workforce monitoring linked to modernised funding and contracting. Tailored national implementation within a shared European framework will be essential to rebuild sustainable GP capacity.</p>","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"2 6","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414675","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":"Correction to <i>Lancet Prim Care</i> 2026; 2: 100166.","authors":"","doi":"10.1016/j.lanprc.2026.100188","DOIUrl":"10.1016/j.lanprc.2026.100188","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1016/j.lanprc.2026.100166.].</p>","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"2 6","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407888","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":"Mainstreaming neglected tropical disease interventions into primary health care: accelerating elimination and sustaining gains.","authors":"Kebede Deribe, Esmael Habtamu","doi":"10.1016/j.lanprc.2026.100177","DOIUrl":"10.1016/j.lanprc.2026.100177","url":null,"abstract":"","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"2 6","pages":"100177"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7619231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148428637","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":"Chemical adherence testing-guided intervention versus standard of care in patients with hypertension who are non-adherent to antihypertensive treatment in the UK (OUTREACH): a multicentre, randomised controlled trial.","authors":"Maciej Tomaszewski, Pankaj Gupta, Philip Chowienczyk, Baptiste Leurent, Shadi Hames-Fathi, Luana Lenzi, Luca Faconti, S M L Abrams, Marc George, Heather Buchanan, Andrew Jordan, Stephen Walsh, Victoria Robinson, Ahmed Adlan, Anthony Heagerty, Iain Squire, Robert Horne, Eileen Jones, Ewan McFarlane, David Collier, Isla S Mackenzie, Prashanth Patel, Thomas M MacDonald, Alexander Thompson, Peter Lacy, Pauline A Swift, Bryan Williams","doi":"10.1016/j.lanprc.2026.100154","DOIUrl":"10.1016/j.lanprc.2026.100154","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Biochemical urine analysis by liquid chromatography-mass spectrometry analysis (ie, chemical adherence testing [CAT]) is an objective method of detecting non-adherence to antihypertensive treatment. We aimed to assess whether an intervention based on providing non-adherent patients with hypertension with information on their urine analysis results combined with a discussion of the main reasons for non-adherence (CAT-guided intervention) would lead to a cost-effective improvement in adherence, blood pressure, and urinary excretion of albumin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;OUTREACH was a multicentre, randomised controlled trial in 12 UK secondary or tertiary outpatient centres and primary care services. We recruited non-pregnant patients with hypertension who were older than 18 years and were on at least two antihypertensive medications. Participants who were non-adherent to antihypertensive treatment based on the results of their first urine CAT were randomly assigned (1:1) either to the intervention (discussion of the results of the urine CAT; group A) or standard of care (group B) after visit 2. The sequence of randomisation was computer-generated through an automated randomisation service (Sealed Envelope), which used minimisation as a method of allocation based on recruitment site, baseline systolic blood pressure, age, sex, number of antihypertensive medications prescribed at visit 1, the improvement in biochemical adherence to antihypertensive treatment between visits 1 and 2, and a random element to ensure the unpredictability of the assignment. The primary outcome was the mean clinic systolic blood pressure measured at visit 4. All analyses were based on the intention-to-treat principle. The trial was registered with ClinicalTrials.gov (NCT03293147) and is completed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Between Feb 4, 2019, and Feb 1, 2023, 879 patients were assessed for eligibility, 748 of whom were excluded after visit 1; 720 because they were either adherent or had unconfirmed adherence status on urine CAT. 70 adherent individuals were retained on the study for masking purposes but were not a part of the two-arm randomised component of the study. 130 non-adherent patients included in the study were randomly assigned to the intervention group (A; n=65) or the standard of care group (B; n=65). 71 (55%) participants were male and 59 (45%) were female; 57 (44%) were White, 22 (17%) were Asian or Asian British, 49 (38%) were Black, African, Caribbean, or Black British, and two (2%) were other ethnicities. The median follow-up after the intervention to visit 4 was 2·8 months (IQR 2·2-4·3). Mean clinic systolic blood pressure at visit 4 was 150·9 mm Hg (SD 24·7) in 56 participants in group A and 151·1 mm Hg (24·4) in 55 participants in group B (adjusted mean difference -5·1 mm Hg [95% CI -12·7 to 2·5]; p=0·19). 33 adverse events were reported (11 in group A and 22 in group B). 12 serious adverse events were record","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"2 5","pages":"100154"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274619","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":"Population expectations of primary care quality in 18 countries: a cross-sectional analysis of data from the People's Voice Survey.","authors":"Todd P Lewis, Shalom Sabwa, Joao Breda, Susanne Carai, Emma Clarke-Deelder, Svetlana V Doubova, Günther Fink, Patricia J Garcia, Ezequiel Garcia-Elorrio, Hwa-Young Lee, Sailesh Mohan, Inbarani Naidoo, Juhwan Oh, Emelda A Okiro, Ashenif Tadele, Rosanna Tarricone, Marius-Ionuț Ungureanu, Xiaohui Wang, Dong Roman Xu, Margaret E Kruk","doi":"10.1016/j.lanprc.2026.100151","DOIUrl":"10.1016/j.lanprc.2026.100151","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Expectations for health-care quality affect how populations rate primary care, influencing tolerance of poor-quality care and demand for improvement, yet how expectations align with standards of practice remains poorly understood. We aimed to measure population expectations of primary care and their determinants within and across countries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this cross-sectional analysis, we used nationally representative data from the People's Voice Survey collected between May 9, 2022, and Dec 21, 2023, in Ethiopia, Nigeria, Kenya, South Africa, Colombia, Peru, Mexico, Argentina (Province of Mendoza), Uruguay, Laos, India, China, South Korea, Romania, Greece, Italy, the UK, and the USA. Adults aged 18 years and older with at least one health-care visit in the past 12 months were included. Expectations were assessed using two anchoring vignettes, one depicting poor-quality primary care and one depicting adequate-quality primary care, administered via a mobile telephone survey, household interview, or nationally representative web panels. Respondents rated each vignette on a Likert scale: poor, fair, good, very good, or excellent. Low expectations were defined as rating the poor-quality care vignette as fair, good, very good, or excellent, and high expectations were defined as rating the adequate-quality care vignette as poor, fair, or good. Multivariable logistic regression models identified determinants of expectations, including covariates covering demographics, health status, care utilisation and experience, and system competence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Among 18 312 respondents (10 000 [54·6%] female and 8312 [45·4%] male; mean age 44 years [SD 17]), 2955 (16·1%) rated poor-quality primary care as fair or better and 11 787 (64·4%) rated adequate-quality primary care as less than very good. The proportion of respondents with low expectations of primary care ranged from 70 (6·3%) of 1112 in the UK to 530 (41·1%) of 1290 in South Korea. The proportion of respondents with high expectations of primary care ranged from 563 (40·1%) of 1404 in Nigeria to 494 (85·0%) of 581 in Italy. Older age, female gender, higher educational attainment, higher income, and use of private care (&lt;i&gt;vs&lt;/i&gt; public care) were all associated with reduced odds of low expectations. Respondents with higher self-rated health had higher odds of low expectations (&lt;i&gt;vs&lt;/i&gt; those with poor self-rated health). Activated patients (ie, those who were confident in raising concerns with their provider and that they were responsible for managing their own health) had lower odds of low expectations and lower odds of high expectations (&lt;i&gt;vs&lt;/i&gt; non-activated patients). And positive perceptions of government management of COVID-19 were associated with high odds of low expectations and low odds of high expectations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Populations can often misjudge primary care quality, with substantial cross-","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"2 5","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274599","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":"Kidney outcomes with GLP-1 receptor agonists in people with type 2 diabetes already receiving SGLT2 inhibitors: a target trial emulation study using UK primary care data.","authors":"Thijs T Jansz, Andrew P McGovern, Katherine G Young, Martha M Dinsdale, Pedro Cardoso, Beverley M Shields, Andrew T Hattersley, Angus G Jones, Ewan R Pearson, Coralie Bingham, Richard A Oram, John M Dennis","doi":"10.1016/j.lanprc.2026.100139","DOIUrl":"10.1016/j.lanprc.2026.100139","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Type 2 diabetes is the leading cause of kidney failure and is predominantly managed in primary care. Large randomised trials have shown that GLP-1 receptor agonists and SGLT2 inhibitors each slow kidney disease progression, but their combined effect on kidney outcomes remains unclear. We aimed to evaluate the comparative effectiveness of GLP-1 receptor agonists versus DPP-4 inhibitors or sulfonylureas on kidney outcomes in individuals with type 2 diabetes already receiving SGLT2 inhibitor treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this observational study, we emulated a pragmatic target trial using an active-comparator, new-user cohort design with UK primary care electronic health record data (Clinical Practice Research Datalink, March 31, 2013-March 31, 2023) with linkage to hospital inpatient, deprivation, and mortality data. We included individuals with type 2 diabetes already receiving SGLT2 inhibitors who newly initiated either GLP-1 receptor agonists or comparator drugs DPP-4 inhibitors or sulfonylureas. We excluded those with estimated glomerular filtration rate (eGFR) of less than 20 mL/min per 1·73 m&lt;sup&gt;2&lt;/sup&gt; or end-stage kidney disease. Individuals in the comparator group who initiated a GLP-1 receptor agonist during follow-up were censored at the date of GLP-1 receptor agonist initiation and subsequently re-entered into the GLP-1 receptor agonist group. We followed up all initiations regardless of subsequent treatment discontinuation (intention-to-treat analysis), with a maximum follow-up of 3 years. The primary outcome was kidney disease progression (defined as occurrence of ≥40% eGFR decline, end-stage kidney disease, or death from kidney-related causes). Safety outcomes were acute pancreatitis and incident retinopathy (among those without a recorded history at baseline). We estimated hazard ratios (HRs) using Cox proportional hazards models with double-robust overlap weighting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;We included 33 659 treatment initiations (20 039 GLP-1 receptor agonists and 13 620 DPP-4 inhibitors or sulfonylureas; among 31 650 unique individuals), of whom these initiations occurred among 20 239 (60%) male individuals and 13 420 (40%) female individuals; median age was 60 years (IQR 53-67), and 26 530 (79%) were White, 4492 (13%) south Asian, 1398 (4%) Black, and 1239 (4%) of other ethnicities. Over a median follow-up of 1·4 years (IQR 0·6-3·0), kidney disease progression occurred in 187 (0·9%) of 20 039 individuals who initiated a GLP-1 receptor agonist and 189 (1·4%) of 13 620 who initiated a DPP-4 inhibitor or sulfonylurea. GLP-1 receptor agonist initiation was associated with a lower risk of kidney disease progression compared with DPP-4 inhibitor or sulfonylurea initiation (HR 0·73 [95% CI 0·58-0·92]). GLP-1 receptor agonist initiation was not associated with occurrence of acute pancreatitis (32 [0·2%] of 19 727 individuals with no recorded history of pancreatitis who initiated ","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"2 4","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147871259","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}