The Lancet. Primary care最新文献

{"title":"Organisation of health services for the delivery of primary health care in the WHO African region: a future perspective.","authors":"Humphrey Karamagi, Anabay Mamo, Benson Droti, Benjamin Tsofa, Sokona Sy, Solyana Kidane, Nelida Cabral, Juliet Nabyonga, Prosper Tumusiime","doi":"10.1016/j.lanprc.2026.100122","DOIUrl":"10.1016/j.lanprc.2026.100122","url":null,"abstract":"<p><p>Despite decades of investment in health systems across the WHO African region, population health outcomes remain suboptimal. The region faces evolving challenges, including demographic shifts, emerging health threats, and persistent inequalities. Current health-service delivery models are misaligned with anticipated future health demands, necessitating a reimagined operational framework grounded in a revitalised primary health-care approach. In this Viewpoint, we draw on expert consensus from professionals across 19 countries using the nominal group technique and Delphi-style rounds. Experts were organised into thematic \"policy laboratories\" focusing on primary care, hospitals, and oversight. Expert insights were collected through structured questionnaires, thematic analysis, and iterative validation, culminating in a 5-day consensus workshop. Three key constructs emerged for future health-service organisation: (1) primary care units as integrated networks delivering first point-of-care interventions; (2) hospitals redefined to include training, research, and clinical governance roles; and (3) oversight structures with decentralised, participatory, and evidence-informed decision-making capacities. The proposed model emphasises person centredness, functional integration, and digital innovation to enhance system responsiveness and resilience. The future of health-service delivery in Africa lies not in replacing existing structures, but in repurposing and realigning them to meet population health needs. Incremental reforms, supported by digital tools, essential health packages, and rationalised service-provision modalities, can enable countries to build resilient, people-centred health-care systems. National and subnational leadership, supported by regional and global partners, is essential for driving this transformation.</p>","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/PMC13153028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147871278","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":"Embedding social prescribing in primary care in England and Scotland: a qualitative study of experiences, roles, challenges, and sustainability.","authors":"Eddie Donaghy, Stewart W Mercer, Heather Brant, Hilllary Collins, Manal Etemadi, Yuri Hamashima, Hugh McLeod, Catherine A O'Donnell, Caroline Sanders, Mihirini Sirisena, Paul Wilson","doi":"10.1016/j.lanprc.2026.100128","DOIUrl":"10.1016/j.lanprc.2026.100128","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In the last decade, social prescribing through link workers based in general practice has become a major policy in the UK, but little is known about the implementation of this strategy. We aimed to explore the roles, challenges, and effects of social prescribing link workers (SPLWs) across different models of employment, organisation, and management in England and Scotland.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this qualitative study, we conducted semi-structured interviews with stakeholders in two regions in England (National Institute for Health and care Research [NIHR] Applied Research Collaboration [ARC] West and NIHR ARC North East and North Cumbria) and two in Scotland (National Health Service [NHS] Greater Glasgow & Clyde and NHS Lothian). Stakeholders were participants actively involved in SPLW activities and comprised patients aged 18 years or older receiving SPLW support; individual SPLWs; general practice staff who referred patients to the SPLW; leads of voluntary, community, and social enterprises (VCSEs) employing or hosting SPLWs; VCSE leads not employing or hosting SPLWs but supporting referred patients; and strategic leaders working with SPLW services. Purposive sampling was used to ensure diversity in patients' age, gender, and socioeconomic deprivation (according to the Index of Multiple Deprivation in England or Sottish Index of Multiple Deprivation in Scotland) and variation in stakeholder roles. Interviews were continued until data saturation was reached. Transcribed interviews were analysed reflexively using inductive thematic analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Between Feb 16 and Nov 15, 2024, we conducted interviews with 130 stakeholders: 36 SPLWs, 28 patients, 28 referring professionals, ten VCSE leads hosting SPLWs, 14 VCSE leads not hosting SPLWs, and 14 strategic leads. Patient ages ranged from 18 years to older than 65 years; 16 (57%) patients were female, 12 (43%) were male, 26 (93%) were of White British or Scottish ethnicity, one (4%) was of south Asian ethnicity, and one (4%) was of mixed or multiple ethnicity. Six key themes emerged. The first was varied backgrounds, with SPLWs typically coming from the voluntary sector or NHS, driven by a desire to empower patients. The second was changing role, with SPLWs now seeing many more patients with highly complex needs, including the social determinants of health in deprived areas, than they did previously. The third theme was therapeutic relationship, whereby building empathic relationships was crucial but depended on SPLWs' backgrounds, training, and support. The fourth theme, benefits of the SPLWs, was based on SPLWs helping patients to build confidence and increase their independence and, in general practitioners, reducing moral distress and possibly reducing workload. The fifth theme was employment models, organisation, and management, with integration into general practices facilitated by SPLWs working in one or two practices an","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/PMC13154165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147871285","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":"Artificial intelligence in primary care: innovation at a crossroads.","authors":"Liliana Laranjo, Lorainne Tudor Car, Rebecca Elizabeth Payne, Ana Luisa Neves, Michael Kidd, J Jaime Miranda","doi":"10.1016/j.lanprc.2025.100078","DOIUrl":"10.1016/j.lanprc.2025.100078","url":null,"abstract":"<p><p>Despite being a cornerstone of health-care delivery, primary care is increasingly under strain. The latest advancements in artificial intelligence (AI) offer new opportunities to transform primary care. However, the rapid deployment of AI ahead of robust real-world evaluation or regulation raises concerns about unintended consequences on the quality of care. We review applications of AI in primary care, covering AI to support primary care providers and people with their health. This Review considers the impact of AI applications on different domains of health-care quality-effectiveness, safety, timeliness, efficiency, patient-centred care, health-care provider experience, equity, and planetary health-and on the primary care-specific attributes of accessibility, comprehensiveness, coordination, and continuity. Implementation of AI in primary care benefits from careful consideration of these quality domains, a focus on universal design principles, digital determinants of health, and AI health literacy, and alignment with patient experiences and values, to support the transformation towards sustainable and high-quality AI-enabled primary care.</p>","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"2 3","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13061652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680268","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":"Defining recurrent urinary tract infections and quantifying bladder cancer risk in primary care in England: a nationwide case-control study.","authors":"Sikhuphukile G Mahati, Jianhua Wu, Fiona M Walter, Yin Zhou","doi":"10.1016/j.lanprc.2025.100103","DOIUrl":"10.1016/j.lanprc.2025.100103","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Around 30-40% of people with bladder cancer in England present with symptoms or diagnosis of urinary tract infection (UTI) in the year before a diagnosis of bladder cancer. National Institute for Health and Care Excellence guidelines advise referral of people aged 60 or older with unexplained recurrent UTIs to specialists, but recurrence is ambiguously defined, risking delayed diagnosis and worsened outcomes. We aimed to better define and quantify the effect of recurrent UTIs on the likelihood of bladder cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this nationwide retrospective case-control study, we collected data from people aged 18 years or older with bladder cancer diagnosed between Jan 5, 1998, and Dec 31, 2018, and who had at least one UTI before diagnosis from the National Cancer Registration and Analysis Service (NCRAS) and the Clinical Practice Research Datalink (CPRD) in England. NCRAS diagnosis and dates were preferentially used. We matched each patient with bladder cancer (ie, case) to five patients without bladder cancer (ie, controls) using age at cancer diagnosis, sex, and general practice. Primary analyses examined the associations between UTI frequency (one, two, three, four, and five or more episodes) and bladder cancer using conditional logistic regression, within predefined look-back intervals up to 5 years before the index UTI (eg, the most recent UTI before their cancer diagnosis).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;We identified 92 277 patients registered with English primary care practices contributing to CPRD and 13 227 contributing to NCRAS, including 17 584 patients with bladder cancer (cases) and 87 920 without bladder cancer (controls). After excluding 7513 duplicates and 42 526 controls who had no UTIs before a diagnosis, then further excluding 1529 patients (427 cases and 1102 controls) who had a UTI 5-10 years before the index UTI, we included 53 936 patients for analysis (17 157 cases and 36 779 controls). There were more male (9992 [58·2%]) than female (7165 [41·8%]) patients with bladder cancer; with a median age of 75·0 years (IQR 67·0-81·0); and patients were White (16 028 [93·4%]), Asian (189 [1·1%]), Black (139 [0·8%]), or mixed race (31 [0·2%]) and of other (91 [0·5%]) and unknown ethnic groups (679 [4·0%]). There was a higher proportion of female than male patients without bladder cancer (19 858 [54·0%] &lt;i&gt;vs&lt;/i&gt; 16 921 [46·0%]). A dose-response relationship between recurrent UTI and bladder cancer risk was seen in the first 6 months only, with the largest effect for five or more UTIs at 0-6 months (adjusted odds ratio 13·05 [95% CI 11·60-14·68]); patients with five or more UTIs had around 2·5-times higher odds than those with three UTIs in the same interval (4·95 [4·51-5·43]). Associations attenuated with increasing time from the index UTI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Our data suggest that recurrent UTIs within 6 months were a strong signal of bladder cancer risk. Ou","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"2 2","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470742","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":"Post-COVID-19 condition and disparities in daily functional activities in England: a retrospective analysis of data from the Virus Watch community cohort.","authors":"Wing Lam Erica Fong, Sarah Beale, Vincent Grigori Nguyen, Jana Kovar, Alexei Yavlinsky, Andrew C Hayward, Ibrahim Abubakar, Sander M J van Kuijk, Robert W Aldridge","doi":"10.1016/j.lanprc.2025.100093","DOIUrl":"10.1016/j.lanprc.2025.100093","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Post-COVID-19 condition is increasingly recognised to impair daily functioning. In the UK and many other settings worldwide, primary care is the first point of contact and key provider of care for people with the condition. Consequently, identifying groups at heightened risk allows primary care services to tailor assessment, support, and referral pathways more effectively. This analysis aims to investigate the role of socioeconomic deprivation, migration status, and ethnicity in experiencing limitations in six functional activities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used data from Virus Watch, a prospective community cohort study in England and Wales, which enrolled 58 628 participants between June 22, 2020, and March 31, 2025. Participants self-reported new persistent symptoms and their effects on six functional activities (work or education, concentration, self-care, care for others, performance of necessary activities outside the house, and engagement in enjoyable activities) through six surveys over 4 years (2021-24). In this retrospective analysis, participants were included if they (1) were aged 18 years or older and lived in England; (2) were successfully linked to national hospitalisation, COVID-19 testing and vaccination, and mortality data; (3) were not admitted to hospital for or with COVID-19; and (4) self-reported persistent symptoms that met the WHO consensus definition of post-COVID-19 condition. Logistic regression was used to assess how deprivation level, migration status, and ethnic minority status were associated with the odds of experiencing each functional limitation, adjusting for sociodemographic variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;776 individuals with post-COVID-19 condition were included in this analysis (552 [71%] female, 224 [29%] male; 685 [88%] White British, 88 [11%] ethnic minority, and 11 [1%] missing ethnicity). 686 (88%) reported experiencing limitations in at least one daily activity. Individuals with post-COVID-19 condition in Index of Multiple Deprivation quintile (IMD) 1 (the most deprived quintile) had higher adjusted odds of limitations in work or education (adjusted odds ratio [aOR]; 2·30 [95% CI 1·12-4·93]), concentration (2·78 [1·42-5·81]), self-care (2·11 [1·06-4·16]), and doing necessary activities outside the house (2·06 [1·12-3·90]) than those in IMD 5 (the least deprived). Those in IMD 2 also experienced increased odds of limitations in work or education (1·90 [1·09-3·34]) and concentration (1·91 [1·17-3·14]) compared to those in IMD 5. We found no evidence of associations between migration status or minority ethnicity status with functional limitations (migration status aOR range from 0·67 [0·25-1·73] to 1·52 [0·64-3·77]; minority ethnicity status aOR range from 0·66 [0·35-1·17] to 1·41 [0·82-2·53]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Socioeconomic deprivation, rather than migration status or ethnicity, primarily drives functional limitations within this","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"2 1","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12867958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146129195","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":"Health inequalities and trends in heart failure diagnosis in primary care in England, 2000-21: a national retrospective cohort data-linkage study.","authors":"Claire A Lawson, Mohammad R Ali, Gerry P McCann, Iain Squire, Francesco Zaccardi, Muhammad Rashid, Kelly Barber, Riaz Alaei Kalajahi, Christopher A Miller, Rhys Williams, Andrew L Clark, Mark C Petrie, Clare J Taylor, Jocelyn M Friday, Nathalie Conrad, John G F Cleland, Kamlesh Khunti","doi":"10.1016/j.lanprc.2025.100060","DOIUrl":"10.1016/j.lanprc.2025.100060","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Heart failure is often diagnosed during unplanned admission to hospital, which is associated with poor outcomes. The aim of this study was to examine the potential for early heart failure identification in primary care, trends in diagnostic practices, sociodemographic inequalities, and the association between diagnostic pathways and outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective cohort study using the Clinical Practice Research Datalink. Adults aged 18 years or older with newly diagnosed heart failure were identified from linked primary care and hospital records in England between Jan 1, 2000, and March 31, 2021. From primary care records, we analysed heart failure indicators (ie, breathlessness, ankle swelling, and loop diuretic use) recorded up to 5 years before diagnosis and diagnostic investigations (ie, natriuretic peptide tests, echocardiography, and specialist review) recorded within the previous 6 months. Trends over time and differences among sociodemographic groups are reported. Associations between diagnosis timing, investigation use, location (inpatient &lt;i&gt;vs&lt;/i&gt; outpatient) and the primary outcome of 1-year survival were assessed, with analyses restricted to Jan 1, 2015, to Dec 31, 2019. Associations were adjusted for age, sex, ethnicity, socioeconomic status, year of diagnosis, systolic blood pressure, BMI, cholesterol, smoking, comorbidities, and prescribed drugs at diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Among 412 173 new heart failure diagnoses (median age 78·0 years [IQR 69·0-85·0]), 194 175 (47·1%) were women and 217 998 (52·9%) were men. In 407 622 participants with ethnicity data, ethnicity was recorded as White for 375 808 (92·2%), south Asian for 11 644 (2·9%), Black for 6994 (1·7%), other or mixed for 3622 (0·9%), and unknown for 9554 (2·3%). Although 274 228 (66·5%) of 412 173 patients had previous heart failure indicators, diagnostic timing worsened over the study period (2000-04 to 2015-19), with a median lag time increasing from 16·4 months (IQR 1·6-45·7) to 35·4 months (6·4-54·7) and the proportion of inpatient diagnoses rising from 30 560 (33·9%) of 90 136 patients to 55 905 (46·8%) of 119 355 patients. Among 80 824 individuals with previous indicators suggestive of heart failure diagnosed between Jan 1, 2015, and Dec 31, 2019, only 10 079 (12·5%) patients underwent natriuretic peptide testing, 15 986 (19·8%) had echocardiography, 27 804 (34·4%) were referred to specialists, and 42 302 (52·3%) had no diagnostic investigations recorded in primary care. Women, individuals living in deprived quintiles, and those with multiple long-term conditions had up to five times longer delays, lower investigation rates, and a higher likelihood of hospital diagnosis. Delays (adjusted hazard ratio [HR] 1·15 [95% CI 1·10-1·20]), absence of investigations (1·89 [1·83-1·95]), and inpatient diagnosis (2·58 [2·50-2·66]) were all associated with higher mortality. Mortality was low","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"1 6","pages":"None"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12728148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835584","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 oral pre-exposure prophylaxis delivery in primary care family planning clinics: a pragmatic, stepped-wedge, cluster-randomised trial.","authors":"Kenneth K Mugwanya, Daniel Matemo, Allison Meisner, Torin Schaafsma, Jennifer Morton, Cynthia Wandera, Valarie Kemunto, Irine Cherotich, Stephen Odhiambo, Mercy Bii, Beatrice Oduor, Esther Achieng, Tecy Oyombra, David Owaga, Kristin M Beima-Sofie, Jared M Baeten, John Kinuthia","doi":"10.1016/j.lanprc.2025.100057","DOIUrl":"10.1016/j.lanprc.2025.100057","url":null,"abstract":"<p><strong>Background: </strong>Integrating pre-exposure prophylaxis (PrEP) delivery in family planning (FP) settings may offer an efficient platform to reach women at elevated risk for HIV.</p><p><strong>Methods: </strong>We conducted a stepped-wedge cluster randomized trial to integrate systematic screening for HIV risk and PrEP delivery in twelve public FP clinics in Kisumu County, Kenya. Clients were HIV-negative women 15-49 years accessing the participating clinics. Each clinic represented a cluster, and four clinics sequentially transitioned from usual care (control) to the intervention period in a randomized staged order every three-month interval. The intervention included provider training and technical support to build FP clinic staff capacity to deliver PrEP as part of the standard of care. There was no masking. Oral PrEP was free to clients. A subset of women assessed to be at elevated HIV risk including those who declined PrEP were enrolled in nested cohort and followed quarterly up to 24 months to measure HIV incidence. The primary outcomes were the proportion of women screened for oral PrEP among those attending FP clinics and PrEP initiation among women screened and assessed to be eligible for PrEP. Analysis was intention-to-treat, with all women not known to be living with HIV at the first clinic visit encounter included in the analysis for the HIV risk and PrEP screening outcome. This trial is registered with ClinicalTrials.gov., NCT04666792 and completed.</p><p><strong>Results: </strong>Between March 1, 2021 and December 31, 2022, 25457 HIV-negative women visited twelve FP clinics contributing 7386 woman-encounters during control period and 21343 woman-encounters during the intervention period. Median age was 27 (IQR 23-31) years. The proportion of woman-encounters screened for PrEP significantly increased from 2.9% (213/7386) to 91.6% (19560/21343) (relative risk: 20·5, 95%CI 3·5-120.4; p=0·0008). Oral PrEP initiation among women assessed to be at elevated HIV risk increased from 3.9% (5/120) to 40.6% (985/2429) (relative risk: 50·1, 95%CI 2·8-913.4; p=0·0082). Five HIV infections occurred during 833·4 women-years of cohort follow-up (incidence 0.60 95%CI 0.19-1.40 per 100 woman-years). All infections were in women who either declined PrEP (n=3) or had undetectable tenofovir diphosphate in dried blood spots at multiple visits prior to seroconversion (n=2).</p><p><strong>Interpretation: </strong>An implementation intervention package to build capacity of public clinic FP healthcare providers successfully led to integration of oral PrEP delivery in real-world FP clinics in Kenya. These findings could help inform similar strategies in FP clinics in other African settings.</p>","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"1 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13225875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152671","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":"Prescription opioid use and opioid use disorder among older adults with HIV in the USA from 2008 to 2021: a retrospective repeated cross-sectional study.","authors":"Stephanie Shiau, Fabrizio Drago, Carolyn W Kinkade, Kylie Getz, Greta Bushnell, Hillary Samples, Alexis A Bender, Laura Bennett, Chintan Dave, Perry N Halkitis, Tobias Gerhard, Jason A Roy, Silvia S Martins, Michael T Yin, Stephen Crystal","doi":"10.1016/j.lanprc.2025.100017","DOIUrl":"10.1016/j.lanprc.2025.100017","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is longstanding concern that people with HIV receive prescription opioids at higher rates and have a disproportionate burden of opioid use disorder (OUD) compared with their counterparts without HIV. We aimed to evaluate trends of opioid prescriptions and indicators of OUD in an understudied but growing population of older adults with HIV.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;For this retrospective repeated cross-sectional study, we constructed annual cohorts through a nationally representative sample of fee-for-service Medicare beneficiaries aged 65 years and older in the USA with Part D coverage (ie, prescription drug) enrolled between Jan 1, 2008, and Dec 31, 2021. Beneficiaries were eligible for inclusion in each cross-sectional cohort if they had reached the age of 65 years by Jan 1 of the calendar year and had 1 year of continuous Medicare enrolment in Part A (inpatient hospital care), B (outpatient care), and D. Beneficiaries with HIV were matched in a 1:3 ratio to beneficiaries without HIV on age, sex, race or ethnicity, US state, and dual eligibility status (Medicare and Medicaid). The main outcomes were receipt of at least one opioid prescription and any indicator of OUD (ie, formal diagnosis, medication for OUD, or opioid-related or emergency department visits) during each calendar year. Generalised estimating equations were used to estimate odds ratios (ORs) of each outcome, comparing matched beneficiaries with or without HIV. Due to data availability, our analysis of indicators of OUD was restricted to 2008-16.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Across all years, 163 429 beneficiaries with HIV and 490 287 beneficiaries without HIV were included (475 516 [72·7%] were male, 178 200 [27·3%] were female; 305 776 [46·8%] were non-Hispanic White, 238 172 [36·4%] were Black [or African American], 84 128 [12·9%] were Hispanic, 8964 [1·4%] were Asian or Pacific Islander, and 16 676 [2·6%] were other races or ethnicities). During 2008-21, 57 373 (35·1%) of 163 429 people with HIV and 138 547 (28·3%) of 490 287 people without HIV received at least one opioid prescription. During 2008-16, 2408 (3·1%) of 76 637 people with HIV and 2831 (1·2%) of 229 911 people without HIV had any indicator of OUD. Across all analysed years, beneficiaries with HIV had significantly increased odds of receiving at least one opioid prescription (OR 1·38, 95% CI 1·36-1·39) and having indicators of OUD (2·61, 2·47-2·76) compared with their matched counterparts without HIV.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Medicare beneficiaries aged 65 years and older with HIV in the USA were more likely to receive opioid prescriptions and have OUD indicators than matched beneficiaries without HIV. Our findings could help guide clinical opioid prescription guidelines and public health surveillance among this vulnerable ageing population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding: &lt;/strong&gt;National Institute on Drug Abuse, New Jersey Alliance for Clinical and Translatio","PeriodicalId":521027,"journal":{"name":"The Lancet. Primary care","volume":"1 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12709593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784363","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":"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}