BMC primary care最新文献

{"title":"Pathways to a diagnosis of trigeminal neuralgia: a qualitative study of patients' experiences.","authors":"Cameron Werner, Jeni Harden, Julia Lawton","doi":"10.1186/s12875-025-02763-8","DOIUrl":"https://doi.org/10.1186/s12875-025-02763-8","url":null,"abstract":"<p><strong>Background: </strong>Trigeminal Neuralgia (TN) is a rare disorder which causes episodes of intense facial pain and has been described as the 'suicide disease'. Hence, prompt diagnosis and timely initiation of treatment is vital. However, delays to diagnosis and high rates of misdiagnosis are common, particularly within primary care. To date, most research has focused upon treatment options rather than improving diagnostic experiences. This study sought to explore patients' experiences of the events leading up to their TN diagnosis and their views about the care and support they received when they were diagnosed to provide recommendations for improving the TN diagnostic pathway.</p><p><strong>Methods: </strong>This was a qualitative, exploratory study using in-depth interviews. Interviews were conducted with (n = 25) UK-based people with TN recruited via online forums. Data were analysed thematically.</p><p><strong>Results: </strong>Following the onset of their TN pain, most participants described an arduous and uncertain journey to diagnosis, with many encountering significant delays, misdiagnoses and receiving inappropriate referrals and treatment. As a consequence, participants reported experiencing profound distress, anxiety, depression and, in extreme cases, suicidal ideation; some also described drug and alcohol misuse during this time. Most participants conveyed relief upon finally receiving a diagnosis. However, this was often by eclipsed by what they saw as poor and insensitive communication and inadequate information provisioning.</p><p><strong>Conclusions: </strong>The present study highlights the importance of developing bespoke training for primary care and other professionals to facilitate timely recognition of TN symptomatology and ensure that they deliver a TN diagnosis in clear, sensitive and empathetic ways.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"65"},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health nursing consultations in Brazilian primary care: analysis of proposed competencies for advanced practice nurses.","authors":"Patricia Aline de Almeida, Letícia Yamawaka de Almeida, Andrea Liliana Vesga-Varela, Carla Pereira Barreto, Marília Orlandelli Carrer, Keila Gisele Lima Reis, Nayara Vilela de Farias Serranegra, Manoel Vieira de Miranda Neto, Claudia Santos Martiniano, Daiana Bonfim","doi":"10.1186/s12875-025-02761-w","DOIUrl":"https://doi.org/10.1186/s12875-025-02761-w","url":null,"abstract":"<p><strong>Background: </strong>Primary Health Care (PHC) is a key strategy to identify, manage, and coordinate mental health cases. Considering that nurses are essential to integrating mental health care into PHC, initiatives to broaden the discussion and incorporate the role of Advanced Practice Nurses in this setting can help reduce disparities in mental health care. Thus, this study aimed to analyze mental health nursing consultations in PHC and investigate whether nurses have the care management skills proposed for Advanced Practice Nurses.</p><p><strong>Methods: </strong>A multicenter study, with a quantitative and qualitative approach, was conducted in 17 Primary Care Health Units distributed in three regions of Brazil from May to July 2022. Data collection was carried out twice during the nurse's professional practice: nursing consultation (recorded using film, with direct and non-participatory observation) and nursing record. From a quantitative perspective and during the first research stage, consultations that had ≥ 50% compliance with the nursing process were selected so that, in the second qualitative stage, the competencies proposed for Advanced Practice Nurses in PHC were identified through content analysis.</p><p><strong>Results: </strong>A total of 49 mental health nursing consultations were performed by 21 nurses. Of these, seven were selected with a score greater than 50% compliance with the nursing process, carried out by three nurses. The consultations presented few competencies in the care management dimension proposed for the Advanced Practice Nurses; nevertheless, nursing consultation presented 39.68% in the care focus, 38.78% in evaluation and diagnosis, and 47.62% in the provision of care.</p><p><strong>Conclusions: </strong>Nurses who conduct mental health nursing consultations in PHC present, in a scarce and partial way, the competencies proposed for the Advanced Practice Nurses for the care management domain. Hence, the results of this study highlight the need for specific training and policy initiatives to enhance the integration of Advanced Practice Nurses in mental health care within PHC, address existing gaps in care management competencies, and improve the quality of mental health services provided to the population.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"66"},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of clinical practice guidelines and primary care referral pathways for management of otorhinolaryngological conditions in Pakistan.","authors":"Alina Pervez, Russell Seth Martins, Huzaifa Moiz, Abbas Raza Syed, Muneeb Khan, Nashia Ali Rizvi, Mohsin Ali Mustafa, Muhammad Taha Nasim, Alina Abdul Rehman, Shayan Khalid, Saif Ur Rehman, Sarah Nadeem, Adil H Haider, Shabbir Akhtar","doi":"10.1186/s12875-025-02756-7","DOIUrl":"10.1186/s12875-025-02756-7","url":null,"abstract":"<p><strong>Background: </strong>Diseases of the ear, nose, and throat (ENT) account for a significant portion of a primary care physician's practice in Pakistan, a South Asian lower-middle income country. This increasing burden demands comprehensive clinical practice guidelines and primary care clinical referral algorithms to be devised so that general physicians can adequately provide standardized primary health care and prevent needless specialist ENT referrals.</p><p><strong>Methods: </strong>We selected eight guidelines regarding epistaxis, neck masses, hearing loss, Meniere's disease, dysphonia, allergic rhinitis, acute otitis externa, and rhinosinusitis from the American Academy of Otolaryngology-Head and Neck Surgery Foundation as the source guidelines and employed the GRADE-ADOLOPMENT approach to contextualize guidelines by adopting, adapting, or excluding recommendations from these guidelines. Clinical referral algorithms were created using recommendations from the created clinical practice guidelines, with additional recommendations being sought via a best evidence review process.</p><p><strong>Results: </strong>We successfully created local clinical practice guidelines for the eight ENT conditions using the GRADE-ADOLOPMENT process. While most recommendations were adopted in the local clinical practice guidelines, one recommendation for acute otitis externa, hearing loss, and epistaxis and two for allergic rhinitis were adopted with minor changes to provide supporting information. Six recommendations were excluded mostly due to the unavailability of services in Pakistan. Eight clinical referral algorithms were also created which incorporated 17 additional recommendations to fill gaps in clinical practice including four additional recommendations to the epistaxis algorithm, three for neck lumps/mass, rhinosinusitis, and allergic rhinitis, two for acute otitis externa, and one for Meniere's disease and dysphonia algorithms.</p><p><strong>Conclusion: </strong>The newly created clinical practice guidelines will help in the provision of standardized, high-quality care at the primary care level. Concomitantly, the clinical referral pathways can assist the general physicians in the management of patients as well as guide appropriate timely referrals to ENT specialists.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"64"},"PeriodicalIF":2.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569039","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":"Experiences of quality cluster meetings in general practice - Findings from a national survey two years after initiation of quality clusters in Denmark.","authors":"Maria Bundgaard, Line Bjørnskov Pedersen, Jens Søndergaard, Marius Brostrøm Kousgaard, Sonja Wehberg, Dorte Ejg Jarbøl","doi":"10.1186/s12875-025-02759-4","DOIUrl":"10.1186/s12875-025-02759-4","url":null,"abstract":"<p><strong>Background: </strong>A new national model for quality improvement in general practice based on the concept of quality clusters was introduced in Denmark in 2018. A quality cluster is a local group of general practitioners (GPs) meeting regularly to engage in quality improvement on self-selected topics.</p><p><strong>Aim: </strong>To explore (1) GPs' experiences of cluster meetings, and (2) associations between meeting experiences and self-reported benefits of participation.</p><p><strong>Design: </strong>A national cross-sectional survey study in general practice. In 2020, a questionnaire regarding quality clusters was sent to all Danish GPs (n = 3432). GPs self-reported benefits from cluster participation comprised: overall benefit, changes in clinical organization and workflow, changes in drug prescriptions, improved knowledge of guidelines, and improved patient care.</p><p><strong>Results: </strong>1219 GPs (36%) participated. Results showed that cluster meetings were partly or fully perceived to be well organized (89%) and focused on relevant topics (89%), and that meetings took place in a friendly atmosphere (90%) where experiences were shared (93%). Two-thirds of the GPs found that the data was useful (67%), that their cluster showed a high level of commitment (66%), and that agreement was easily reached (61%). Meetings which were perceived as productive, with useful data, and with a high level of commitment were associated with statistically significantly higher odds for reporting benefits across all self-reported benefits investigated.</p><p><strong>Conclusion: </strong>Overall, cluster meetings were perceived positively by the GPs and associated with benefits when experienced as productive, with useful data, and a high level of commitment.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"63"},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543908","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":"Exploring views and experiences of a unique alcohol assertive outreach model, the primary care alcohol nurse outreach service (PCANOS): a qualitative study.","authors":"Clare Sharp, Andrea Mohan, Danielle Mitchell, Niamh Fitzgerald","doi":"10.1186/s12875-025-02755-8","DOIUrl":"10.1186/s12875-025-02755-8","url":null,"abstract":"<p><strong>Background: </strong>There are recognised barriers to engagement with mainstream alcohol services for certain groups within populations. Alcohol assertive outreach is an approach that uses repeated, persistent and flexible methods to engage with patients with alcohol problems from these groups. There are few qualitative studies that explore how alcohol assertive outreach services are experienced by stakeholders. This study focuses on a unique service, The Primary Care Alcohol Nurse Outreach Service (PCANOS), that operated in Glasgow, Scotland and which involved Alcohol Nurses working closely with general practices.</p><p><strong>Methods: </strong>Twenty-three semi-structured qualitative interviews were used to explore staff and patient views and experiences of PCANOS. Interviews were conducted with 18 staff (nine general practice staff, five alcohol nurses, and four strategic staff) and seven patients from across six Deep End general practices.</p><p><strong>Results: </strong>Findings from this study suggest that PCANOS has the potential to engage patients who may have difficulties engaging with mainstream alcohol treatment services. Through PCANOS, the Alcohol Nurses, in collaboration with General Practitioners and other practice staff, were able to engage patients and deliver a flexible, person-centred care service that impacted positively on patients' drinking behaviour and general health and wellbeing.</p><p><strong>Conclusions: </strong>PCANOS was a unique alcohol assertive outreach service that had the potential to engage with people from the most deprived communities in Glasgow, who were not engaging with the mainstream services. Further research could examine the potential benefits of services like PCANOS, including patient outcomes, the economic impact on the wider healthcare system, and its transferability to other settings such as rural areas.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"61"},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544231","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":"Risks of electromagnetic fields from the perspective of general practitioners and pediatricians.","authors":"Felix Forster, Claudia Riesmeyer, Lyn Ermel, Katharina Lüthy, Ronny Jung, Tobias Weinmann","doi":"10.1186/s12875-025-02762-9","DOIUrl":"10.1186/s12875-025-02762-9","url":null,"abstract":"<p><strong>Background: </strong>Although there is little evidence for adverse health effects due to exposure to electromagnetic fields (EMF) below legal limits, worries regarding these effects are relatively frequent in the general population. For many individuals, general practitioners (GPs) and pediatricians are the first point of contact with the health system. Therefore, it is essential to understand their EMF risk perception.</p><p><strong>Methods: </strong>We conducted a cross-sectional mixed methods study inviting 3,000 GPs and 2,000 pediatricians sampled from the German Federal Medical Registry, of which 614 (12.3%) participated in an online survey and 25 participated in focus groups. We estimated the prevalence of high risk perception, poor subjective knowledge regarding EMF, and the relevance of EMF in their everyday work correcting for non-response by Multilevel Regression and Poststratification.</p><p><strong>Results: </strong>About a quarter of physicians indicated high risk perception regarding health and EMF. Relevance was low, with about 40% of GPs and about 20% of pediatricians reporting EMF-related consultations during the last year. About 60% of physicians had poor subjective knowledge. Many physicians said they could not rule out the possibility of adverse health effects of EMF due to insufficient knowledge and expressed a need for information to address this knowledge gap.</p><p><strong>Conclusions: </strong>A substantial part of GPs and pediatricians with high risk perception are physicians with poor subjective knowledge regarding EMF who cannot completely rule out EMF below legal limits as a cause of unspecific, unclear symptoms, and who are therefore open to patients' suggestions of EMF as a potential cause.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"62"},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544627","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":"Patient participation in self-monitoring regarding healthcare of heart failure: an integrated systematic review.","authors":"Sophia Olofsson, Hanna Josephsson, Maria Lundvall, Peter Lundgren, Birgitta Wireklint Sundström","doi":"10.1186/s12875-025-02757-6","DOIUrl":"10.1186/s12875-025-02757-6","url":null,"abstract":"<p><strong>Background: </strong>Self-monitoring in cases of heart failure (HF) can lead to improved health and early detection of states of illness, potentially avoiding unnecessary hospitalisation. Legislation emphasizes the importance of patient participation in health care. This is possible and simplified due to the ongoing digitalisation within the healthcare system. The aim of this study was therefore to describe existing research knowledge on patient participation in self-monitoring regarding healthcare of HF, in the context of digitalisation of healthcare.</p><p><strong>Methods: </strong>A systematic literature review with an integrative approach was conducted February 2021 (6 years) and April 2024 (9 years). The review consisted of 12 articles accumulated from four databases. The review was performed in line with the standards of the PRISMA statement, registration number: PROSPERO 2021:244,252.</p><p><strong>Results: </strong>A total of twelve studies were included, both quantitative and qualitative research. The studies had a wide international spread and included a total of n = 1393 patients aged between 52-77 years, predominantly men. Various aspects of patient participation are the three themes: 'Self-care ability', 'Interaction with healthcare professionals', and 'Empowerment and Individual preferences'. The results indicate that self-monitoring has a predominantly positive effect on self-care behavior and satisfaction with care. Increased awareness and confidence in patients´ own self-care abilities were reported especially in qualitative studies. Through the use of self-monitoring, information and knowledge about HF led to increased control of the disease. Additionally, differences between qualitative and quantitative studies are demonstrated even in this partial result. The qualitative studies showed an increased understanding of disease situations, but corresponding conformity is not shown in quantitative research, and an increased level of knowledge is not yet proven.</p><p><strong>Conclusions: </strong>The fact that there is a lack of empirical data in this field of research and that the available data is not coherent indicates that additional studies are required. In step with increased digitalisation and that great responsibility is placed on patient participation, there is a demand for patient studies that embrace a pronounced patient perspective with individual components of self-monitoring.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"60"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537990","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":"Experiences of general practice teams and their patients with clinical research-a mixed-methods process evaluation of the Bavarian Research Practice Network (BayFoNet).","authors":"Linda Sanftenberg, Anna-Lena Schnaidt, Stefanie Eck, Antonius Schneider, Eva Bucher, Peter Konstantin Kurotschka, Ildikó Gágyor, Merle Klanke, Stefanie Stark, Thomas Kühlein, Fabian Walter, Marco Roos, Tobias Dreischulte, Jochen Gensichen","doi":"10.1186/s12875-025-02744-x","DOIUrl":"10.1186/s12875-025-02744-x","url":null,"abstract":"<p><strong>Background: </strong>Practice-based research networks (PBRNs) have been implemented to support clinical research in German general practice since 2020. General practitioners (GPs) are often critical concerning the feasibility of clinical trials. Among others, high workload, lack of resources in GP teams and little acceptance of the trial requirements by the patients are assumed barriers. Therefore, the aim of this study was to evaluate the perspectives of the GP teams and their patients on the set up of BayFoNet during the implementation of the two pilot cluster-randomized trials to improve this collaboration on a sustainable basis.</p><p><strong>Methods: </strong>GPs and medical assistants (MAs) were interviewed using semi-structured interviews based on the Consolidated Framework for Implementation Research. Implementation research and verbatim transcripts were analyzed using qualitative content analysis. Patient attitudes were evaluated quantitatively with questionnaires based on the theoretical domains framework using descriptive statistics.</p><p><strong>Results: </strong>A total of 15 GPs and 15 MAs were interviewed, and 109 complete patient questionnaires were returned. Main facilitators for GPs' active participation in clinical research were networking as well as active participation of GP teams at different levels of the research process. Increased awareness concerning PBRNs might promote a lively network. From the GPs' perspective, lack of motivation among MAs and patients was a perceived barrier to support clinical research in general practice. MAs emphasized their own increase in knowledge and competence as well as the importance of clinical research for improved patient care. In contrast to the GPs, most MAs were not aware of BayFoNet as a network structure. The surveyed patients rated their own capabilities and opportunities to actively participate in the pilot studies as very good. Prior to the implementations of the interventions, some patients experienced some difficulty in defining clear goals for their own participation.</p><p><strong>Discussion: </strong>Increased awareness concerning PBRNs might promote a lively network. Target-group specific dissemination strategies as well as opportunities for GP teams and their patients to participate in clinical research should be elaborated. This might increase the feasibility of clinical trials and the motivation of all participants to conduct clinical trials in general practice.</p><p><strong>Trial registration: </strong>Pilot cluster-randomized trial 1 (MicUTI) was prospectively registered on December 19, 2022 at www.</p><p><strong>Clinicaltrials: </strong>gov (NCT05667207); Pilot cluster-randomized trial 2 (IMONEDA) was prospectively registered on April 22, 2022 at www.bfarm.de (DRKS00028805).</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"59"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532027","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":"Digitally supported physical activity counselling for people with chronic back pain: a randomised controlled parallel feasibility study.","authors":"Nicole Lindner, Nele Kornder, Julia Heisig, Annette Becker, Veronika van der Wardt, Annika Viniol","doi":"10.1186/s12875-025-02742-z","DOIUrl":"10.1186/s12875-025-02742-z","url":null,"abstract":"<p><strong>Background: </strong>Guiding individuals with chronic back pain (CBP) to initiate and adhere to physical activity (PA) remains challenging. The study rationale is based on the need for innovative strategies, like digital tools, to better promote PA. The aim of this study was to evaluate the feasibility and acceptability of using the digital consultation app ExPa (Exercise against Pain) to support PA consultations for CBP and its potential for a future effectiveness trial. The ExPa app shows the effect of PA on pain and provides individually tailored support to increase PA.</p><p><strong>Methods: </strong>In a 2-arm randomised controlled feasibility study, we recruited 9 physicians and 37 CBP patients in Hesse (Germany). Using computer assisted cluster randomisation, 14 patients received ExPa counselling from their physician, while 17 patients received standard treatment. Main outcomes focused on study procedures and software use, with secondary outcome including pre- and post-intervention measurements of PA (International Physical Activity Questionnaire (IPAQ), pain and mood (Short Form-12 (SF-12), Von Korff pain intensity and disability score and Hospital Anxiety and Depression Scale (HADS)). Additionally, project-tailored questionnaires and qualitative interviews assessed study procedures and software performance.</p><p><strong>Results: </strong>Study procedures were generally feasible. However, they took more time and dropouts as well as missing data presented challenges. This provided valuable insights for planning an effectiveness trial. Quantitative and qualitative data indicated that ExPa could have benefits for increasing PA and reducing pain.</p><p><strong>Conclusions: </strong>Results from the feasibility study indicate that improved procedures are necessary for a larger RCT. ExPa shows potential for positively impacting pain and PA.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"58"},"PeriodicalIF":2.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525215","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 do people with multimorbidity prioritise healthcare when faced with tighter financial constraints? A national survey with a choice experiment component.","authors":"James Larkin, Louise Foley, Shane Timmons, Tony Hickey, Barbara Clyne, Patricia Harrington, Susan M Smith","doi":"10.1186/s12875-025-02738-9","DOIUrl":"10.1186/s12875-025-02738-9","url":null,"abstract":"<p><strong>Background: </strong>People with multimorbidity (i.e., two or more chronic conditions) experience increased out-of-pocket healthcare costs and are vulnerable to cost-related non-adherence to recommended treatment. The aim of this study was to understand how people with multimorbidity prioritise different healthcare services when faced with tighter budget constraints and how they experience cost-related non-adherence.</p><p><strong>Methods: </strong>A national cross-sectional online survey incorporating a choice experiment was conducted. Participants were adults aged 40 years or over with at least one chronic condition, recruited in Ireland (December 2021 to March 2022). The survey included questions about real-life experiences of cost-related non-adherence and financial burden. The choice experiment element involved participants identifying how they would prioritise their real-world healthcare utilisation if their monthly personal healthcare budget was reduced by 25%.</p><p><strong>Results: </strong>Among the 962 participants, 64.9% (n = 624) had multimorbidity. Over one third (34.5%, n = 332) of participants reported cost-related non-adherence in the previous 12 months, which included not attending a healthcare appointment and/or not accessing medication. Similar findings on prioritisation were observed on the choice task. When presented with the hypothetical tighter budget constraint, participants reduced expenditure on 'other healthcare (hospital visits, specialist doctors, etc.)' by the greatest percentage (50.2%) and medicines by the lowest percentage (24.8%). Participants with multimorbidity tended to have a condition they prioritised over others. On average, they reduced expenditure for their top-priority condition by 71% less than would be expected if all conditions were valued equally, while they reduced expenditure for their least prioritised condition by 60% more than would be expected. Independence, symptom control and staying alive were rated as the most important influencing factors when making prioritisation decisions (median score = 5 out of 5).</p><p><strong>Conclusion: </strong>When faced with tighter financial constraints, people with multimorbidity tended to have a condition they prioritised over others. Participants were also more likely to prioritise medicines over other aspects of healthcare. Researchers, policymakers and clinicians should take greater consideration of the different ways people respond to tighter financial constraints. This could involve reducing the payment barriers to accessing care or clinicians discussing healthcare costs and coverage with patients as part of cost-of-care conversations.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"57"},"PeriodicalIF":2.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525216","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}