BMC primary care最新文献

{"title":"Patient-reported quality of outpatient healthcare in patients with chronic back or arthrosis pain with long-term opioid therapy in Germany.","authors":"Anja Niemann, Nils Frederik Schrader, Christian Speckemeier, Carina Abels, Nikola Blase, Milena Weitzel, Anja Neumann, Cordula Riederer, Joachim Nadstawek, Wolfgang Straßmeir, Jürgen Wasem, Silke Neusser","doi":"10.1186/s12875-025-02881-3","DOIUrl":"10.1186/s12875-025-02881-3","url":null,"abstract":"<p><strong>Background: </strong>Managing patients with chronic non-cancer pain (CNCP) in outpatient healthcare is challenging. Long-term opioid therapy is an option for treatment responders with guideline recommended indications. However, opioid use poses risks of severe side effects, including misuse, and therefore needs to be integrated into a high-quality healthcare process. This analysis evaluates the association between healthcare quality according to the evidence-based Chronic Care Model (CCM) in the treatment process of patients receiving long-term opioid therapy for chronic back and/or arthrosis pain, and patient-related or healthcare related variables.</p><p><strong>Methods: </strong>A cross-sectional patient survey was sent to a random sample of 3,037 individuals with long-term opioid therapy and chronic back and/or arthrosis pain insured by a large nationwide German statutory health insurance. Healthcare quality according to the CCM was assessed by the Patient Assessment of Chronic Illness Care (PACIC-5A) questionnaire. Internal reliability of the assessment instrument was determined using Cronbach's α. Descriptive analysis of the outcome scales were conducted, alongside subgroup analyses considering patient characteristics, patient's health situation, and pain treatment aspects. Testing for statistical significance was performed by Mann-Whitney U test and Kruskal-Wallis test. Effect sizes, namely Eta and Spearman's Rank correlation coefficient, were calculated.</p><p><strong>Results: </strong>The analysis included 661 individuals. Participants were predominantly female (76%) with an average age of 69 years (SD 12.5). PACIC-5A score ratings across all (sub)scales were low, with a summary score rating of 2.4 (on a scale ranging from 1 (worst) to 5 (best)). Positive correlations with treatment quality were observed in the subgroup analysis concerning guideline-compliant pain treatment aspects such as setting therapy goals or a comprehensive treatment concept. Patient characteristics showed little to no correlations, except for a positive correlation between higher PACIC-5A rating and both lower age and higher education. Patient's health situation presented a mixed picture, with no clear correlation between pain intensity/impairment, and PACIC-5A scores.</p><p><strong>Conclusions: </strong>The provision of healthcare for patients with long-term opioid therapy for CNCP seems to be inadequate according to the CCM. Guideline-recommended pain treatment aspects exhibited a positive correlation with healthcare quality according to CCM. Enhancing the implementation of the CCM in the outpatient healthcare process may improve healthcare quality.</p><p><strong>Trial registration: </strong>German Clinical Trials Register, DRKS00024854. Registered 04/28/2021.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"200"},"PeriodicalIF":2.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340751","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":"Brief multidimensional screening tools for young children's mental health and development for administration by primary care providers: a scoping review.","authors":"Ashley D Radomski, Christine Polihronis, Paula Cloutier, Kayla Beaudin, Mario Cappelli","doi":"10.1186/s12875-025-02869-z","DOIUrl":"10.1186/s12875-025-02869-z","url":null,"abstract":"<p><strong>Introduction: </strong>Many young children with mental health or developmental concerns go unidentified and untreated, underscoring the need for effective screening. Primary care offers unique opportunities for screening, yet rates are low. Primary care providers often cite time constraints, insufficient training, and costs as barriers to screening. Tools designed for administration by primary care providers hold promise for facilitating personalized assessments and improving communication, collaboration, and follow-up between providers and families. To improve early identification and intervention, it is crucial to understand provider-administered screening tools that align with their practical constraints.</p><p><strong>Aim: </strong>To identify and describe the characteristics, limitations, and improvement areas of brief, multidimensional screening for young children's mental health and development, designed for administration by primary care providers.</p><p><strong>Methods: </strong>We conducted a scoping review according to published guidelines. We searched seven electronic databases and used hand-searching strategies. We sought English-language publications on screening tools (English or French) assessing at least one mental health and one development domain in children up to 6 years, designed for administration by primary care providers in under 20 minutes. Two reviewers assessed the articles' eligibility and then extracted, charted, and summarized relevant data.</p><p><strong>Results: </strong>Three screening tools from six articles were included. The tools were primarily administered by physicians or nurses to children aged 2 weeks to 4 years and required minimal training to use. The tools varied in their domains (4-6), items (10-110), psychometric properties, and scoring methods, but all included indicators of delayed or at-risk children. Article limitations included study recency and lack of data related to implementation and patient outcomes.</p><p><strong>Conclusions: </strong>This review described the development and evaluation of multidimensional screening tools for young children's mental health and development designed for administration by primary care providers. It found that few tools have been published. This review identifies several knowledge gaps and emphasizes the need for research on the implementation, cost-effectiveness, and comparative performance of screening tools, as well as the development and evaluation of new screening tools that suit providers' needs. Future studies should investigate how these screening tools can improve identification, clinical care, and health outcomes.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"199"},"PeriodicalIF":2.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259502","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":"Physicians' experiences of assessing and supporting fatigued patients in primary care: a focus group study.","authors":"Conrad Samuelsson, Lisa Gunnarsson, Frank Svärdman, Christian Rück, Elin Lindsäter","doi":"10.1186/s12875-025-02891-1","DOIUrl":"10.1186/s12875-025-02891-1","url":null,"abstract":"<p><strong>Background: </strong>Fatigue is a common symptom in primary healthcare, affecting 10-30% of patients, and is associated with increased healthcare consumption and functional disability. There is a lack of standardised guidelines to assess and treat patients with fatigue, and little is known about how patients are currently managed in primary healthcare. This study aimed to explore physicians' experiences of managing patients with fatigue in Swedish primary care to inform development of evidence-based care procedures.</p><p><strong>Method: </strong>Six semi-structured focus group interviews were conducted, including a total of 39 primary care physicians from three primary care centres in Stockholm. Data was analysed using thematic analysis.</p><p><strong>Results: </strong>The analysis generated the overarching theme \"Frustration in the role as physician,\" consisting of two main themes: (1) \"Time pressure and an empty toolbox\", highlighting the perceived lack of standardised assessment procedures, effective interventions, and sufficient time for care; and (2) \"Challenges in the patient-physician relationship\", highlighting role ambivalence, ambivalence regarding sick leave, and the importance of reaching mutual understanding with the patient.</p><p><strong>Conclusion: </strong>Physicians often feel frustrated, ill-equipped, and time-pressured when managing patients with fatigue. There is a pressing need to develop evidence-based assessment procedures and treatments in the primary care context.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"197"},"PeriodicalIF":2.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259504","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":"Opportunities, challenges, and requirements for Artificial Intelligence (AI) implementation in Primary Health Care (PHC): a systematic review.","authors":"Farzaneh Yousefi, Reza Dehnavieh, Maude Laberge, Marie-Pierre Gagnon, Mohammad Mehdi Ghaemi, Mohsen Nadali, Najmeh Azizi","doi":"10.1186/s12875-025-02785-2","DOIUrl":"10.1186/s12875-025-02785-2","url":null,"abstract":"<p><strong>Background: </strong>Artificial Intelligence (AI) has significantly reshaped Primary Health Care (PHC), offering various possibilities and complexities across all functional dimensions. The objective is to review and synthesize available evidence on the opportunities, challenges, and requirements of AI implementation in PHC based on the Primary Care Evaluation Tool (PCET).</p><p><strong>Methods: </strong>We conducted a systematic review, following the Cochrane Collaboration method, to identify the latest evidence regarding AI implementation in PHC. A comprehensive search across eight databases- PubMed, Web of Science, Scopus, Science Direct, Embase, CINAHL, IEEE, and Cochrane was conducted using MeSH terms alongside the SPIDER framework to pinpoint quantitative and qualitative literature published from 2000 to 2024. Two reviewers independently applied inclusion and exclusion criteria, guided by the SPIDER framework, to review full texts and extract data. We synthesized extracted data from the study characteristics, opportunities, challenges, and requirements, employing thematic-framework analysis, according to the PCET model. The quality of the studies was evaluated using the JBI critical appraisal tools.</p><p><strong>Results: </strong>In this review, we included a total of 109 articles, most of which were conducted in North America (n = 49, 44%), followed by Europe (n = 36, 33%). The included studies employed a diverse range of study designs. Using the PCET model, we categorized AI-related opportunities, challenges, and requirements across four key dimensions. The greatest opportunities for AI integration in PHC were centered on enhancing comprehensive service delivery, particularly by improving diagnostic accuracy, optimizing screening programs, and advancing early disease prediction. However, the most challenges emerged within the stewardship and resource generation functions, with key concerns related to data security and privacy, technical performance issues, and limitations in data accessibility. Ensuring successful AI integration requires a robust stewardship function, strategic investments in resource generation, and a collaborative approach that fosters co-development, scientific advancements, and continuous evaluation.</p><p><strong>Conclusions: </strong>Successful AI integration in PHC requires a coordinated, multidimensional approach, with stewardship, resource generation, and financing playing key roles in enabling service delivery. Addressing existing knowledge gaps, examining interactions among these dimensions, and fostering a collaborative approach in developing AI solutions among stakeholders are essential steps toward achieving an equitable and efficient AI-driven PHC system.</p><p><strong>Protocol: </strong>Registered in Open Science Framework (OSF) ( https://doi.org/10.17605/OSF.IO/HG2DV ).</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"196"},"PeriodicalIF":2.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259503","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":"Primary care practices' choice of implementation strategy for continuous glucose monitoring for patients with diabetes: a multiple methods study within a larger hybrid type-3 effectiveness-implementation study.","authors":"Kimberly T Wiggins, Tristen L Hall, Bonnie Jortberg, W Perry Dickinson, L Miriam Dickinson, Jessica A Parascando, Douglas H Fernald, Chelsea Sobczak, Sean M Oser, Tamara K Oser","doi":"10.1186/s12875-025-02903-0","DOIUrl":"10.1186/s12875-025-02903-0","url":null,"abstract":"<p><strong>Background: </strong>Most diabetes care occurs in primary care. Continuous glucose monitoring (CGM) is associated with clinical, behavioral, and psychosocial benefits. While CGM uptake in primary care is increasing, understanding models to support CGM use in diverse primary care practices is needed. The PREPARE 4 CGM study evaluated strategies to implement CGM in primary care. We compared characteristics among practices choosing a practice-led, self-paced CGM implementation strategy or referral to a virtual CGM implementation service that provided patients and their referring primary care practices CGM initiation and data interpretation support for at least six months.</p><p><strong>Methods: </strong>Colorado PC practices interested in implementing CGM enrolled and chose to use the American Academy of Family Physicians Transformation in Practice Series (TIPS): CGM implementation modules or refer patients to a virtual CGM initiation and education service designed and staffed by a primary care multi-disciplinary team. In this multiple methods study, baseline practice characteristics were compared across study arms using chi-square and t-tests. Semi-structured interviews with practice members provided additional context to explain study arm selection.</p><p><strong>Results: </strong>Of 76 practices enrolled, 46 chose self-paced implementation using TIPS modules, 16 of which (35%) had a diabetes care and education specialist (DCES) in the practice; of the 30 that chose the virtual CGM initiation service, none (0%) had a DCES, X²(1, N = 62) = 11.046, p <.001. Aside from having a DCES, no differences in 37 other practice characteristics were seen between groups.</p><p><strong>Conclusions: </strong>Primary care practices were eager to implement CGM. All practices with a DCES chose to implement CGM on their own; of the practices without a DCES, implementation method selection was evenly split (half chose to implement on their own, half chose virCIS). DCESs may have potential as diabetes technology champions in primary care practices. Referral to the virtual CGM implementation service allowed access to a certified DCES and multidisciplinary team for practices without them. As many practices without a DCES also chose to implement CGM on their own, multiple models may be necessary to foster CGM implementation in primary care.</p><p><strong>Trial registration: </strong>This project was reviewed and approved by the Colorado Multiple Institutional Review Board (COMIRB; Protocol 21-4269) and registered with ClinicalTrials.gov on March 23, 2022 (NCT05336214).</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"195"},"PeriodicalIF":2.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259505","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":"Breaking the chains in plato's cave: acute care in general practice.","authors":"Johannes Rieken, Daniel Hötker, Christoph Strumann, Thomas Kötter, Jost Steinhäuser","doi":"10.1186/s12875-025-02901-2","DOIUrl":"10.1186/s12875-025-02901-2","url":null,"abstract":"<p><strong>Background: </strong>It is known that Emergency Departments (EDs) handle lower patient loads during periods when general practitioners (GPs) are on service. However, the acute cases managed by GPs are not well described yet.</p><p><strong>Objective: </strong>This study aims to assess acute medical cases presented at GP's offices.</p><p><strong>Methods: </strong>Medical students documented urgent medical cases as defined by patients during a practice internship in GP practices in Northern Germany, from February to July 2024. Levels of urgency were defined as \"not-acute\" (could have been treated on another day), \"acute\" (had to be treated the same day) and \"emergency\" (had to be treated immediately). Additionally, patient's concerns and expectations were written down and analyzed using qualitative content analyses.</p><p><strong>Results: </strong>A total of 523 cases were collected from 53 practices. The majority of cases (82%) were treated solely within the practice. Regarding levels of urgency, 275 (53%) were graded acute, 170 (33%) were not-acute and 70 (13%) cases were graded emergencies. Patients' motivations for urgently visiting their GP are rooted in fears, motivated by relatives, psychological issues and pain. Expectations range from reassurance to diagnostic examinations to the issuing of a sick leave.</p><p><strong>Discussion: </strong>GPs play a critical role in managing acute medical cases. The holistic approach of GPs including strategies to cope with uncertainty might be useful to be expanded to more specialties of medicine in the acute care sector.</p><p><strong>Conclusion: </strong>Motivations and expectations of a visit to a GP practice were diverse but comprehensible. An additional way to address the fears and uncertainties that send patients to the doctor could be through telemedicine offerings and educational initiatives, potentially starting as early as school age.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"198"},"PeriodicalIF":2.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259501","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":"Patients' and clinicians' experiences of DIALOG+ in primary health care in Bosnia and Herzegovina: a qualitative interview study using thematic analysis.","authors":"Nejra Selak, Hana Sikira, Meliha Kiseljaković, Francois van Loggerenberg, Stefan Priebe, Alma Džubur Kulenović","doi":"10.1186/s12875-025-02845-7","DOIUrl":"10.1186/s12875-025-02845-7","url":null,"abstract":"<p><strong>Background: </strong>DIALOG + is a low-cost intervention proven to improve the subjective quality of life in patients with psychosis and anxiety disorders in low- and middle-income countries. In a recent study, DIALOG + was shown to be feasible for patients in primary care settings with long-term physical conditions and to result in an improvement in patient outcomes. The aim of this qualitative study was to explore the experiences of patients and clinicians using DIALOG + in Bosnia and Herzegovina to gain a better understanding of its impact in this setting.</p><p><strong>Methods: </strong>In-depth semi-structured interviews were conducted with 11 patients and 4 physicians, as well as two focus groups with 5 patients in each, all of whom participated in the intervention. Specific life and treatment domains discussed during the sessions between patients and clinicians were also analysed to determine which domains were most frequently addressed and where patients needed the most support. The interviews were audio-recorded, transcribed, and analysed using thematic analysis.</p><p><strong>Results: </strong>Four qualitative themes were identified: (1) DIALOG + structure and solution-oriented approach are helpful; (2) DIALOG + allows space for conversation; (3) Therapeutic relationship is improved, and (4) The intervention has its limitations.</p><p><strong>Conclusions: </strong>DIALOG + is a novel primary care intervention with positive effects on patients' lives, which enhance primary care. Nevertheless, it presents a new challenge in this setting. It is necessary to make adjustments in primary care, such as providing clinicians with more extensive training and ongoing support, as well as providing more time for the intervention's implementation.</p><p><strong>Trial registration: </strong>Study was registered prospectively within the ISRCTN Registry: ISRCTN17003451, 02/12/2020.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"194"},"PeriodicalIF":2.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251099","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":"Using the RE-AIM framework to evaluate the impact of shared medical appointments for diabetes mellitus: a systematic review and meta-analysis.","authors":"Wei Yang, Run Mao, Ziyun Liang, Zihui Liang, Ruixin Wang, Jiamin Wang, Xufei Luo, Meng Lyu, Dong Roman Xu, Yiyuan Cai","doi":"10.1186/s12875-025-02875-1","DOIUrl":"10.1186/s12875-025-02875-1","url":null,"abstract":"<p><strong>Background: </strong>Diabetes is a major global health concern. However, with proper treatment and management, individuals can lead healthy and fulfilling lives. Shared medical appointment (SMA), an integrated health service, effectively improves the clinical and behavioral outcomes of people living with diabetes (PLWD). Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this review aimed to evaluate the impact of SMA on PLWD treatment and management to inform the feasibility, sustainability, scalability, and equity of future SMA implementation.</p><p><strong>Methods: </strong>Eight electronic databases were searched for randomized controlled trials, non-randomized grouped controlled trials, pre/post studies, and interrupted time series model studies published in English and Chinese until February 2024. The information extraction was guided by the framework for outcome evaluation in implementation science, the RE-AIM framework. We performed meta-analyses for all randomized controlled trials (RCTs) using a random-effects model and presented Forrest plots and test statistics (Cochran's Q and I²) for heterogeneity analysis. Other results that did not lend themselves to quantitative analysis were summarized qualitatively.</p><p><strong>Results: </strong>Forty-seven studies were included in the review. The studies were evaluated according to the RE-AIM framework, and most studies reported effectiveness well, while all other dimensions were poorly reported. Most studies demonstrated that SMA effectively improved patients' Hemoglobin A1c (HbA1c) and Systolic Blood Pressure (SBP) levels and reduced healthcare costs. However, the SMA was a highly resource-demanded and complex intervention package.</p><p><strong>Discussion: </strong>The available evidence suggests that the SMA was beneficial in improving PLWD management and health outcomes among PLWD. However, its complexity would constrain its feasibility and scalability. Future research should assess the effect size of each intervention component and evaluate the implementation process, costs, and maintenance of SMA intervention, especially in resource-limited settings, to improve its sustainability, scalability, and equity.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"192"},"PeriodicalIF":2.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236094","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":"Examining the work-life balance of Australian orthopaedic surgeons.","authors":"Wadad Kathy Tannous, Kingsley Agho, Moin Uddin Ahmed, David R J Gill, Michael Johnson","doi":"10.1186/s12875-025-02880-4","DOIUrl":"10.1186/s12875-025-02880-4","url":null,"abstract":"<p><strong>Background: </strong>Work-life balance (WLB) and preference for work location among Australian orthopaedic surgeons have been a focal point of research and policy discussions in Australia. This study, therefore, aimed to investigate the factors influencing work-life balance among Australian orthopaedic surgeons, and to develop strategies to improve their health and well-being.</p><p><strong>Methods: </strong>An online survey of 288 Australian Orthopaedic Association (AOA) orthopaedic surgeons was conducted, with data collected during October and November 2021 and was weighted to reduce gender bias. Based on the survey question \"What is the main factor that has influenced your choice in your current working location/employment?\" three binary outcome variables were considered: (1) work-life balance (WLB), (2) capacity to undertake the surgeons' preferred area of practice in orthopaedic surgery, and (3) availability of a public appointment and/or achieving a desired private/public mix (public job). Outcome variables were analysed using bivariate and multiple survey logistic regression after adjusting for sampling weights and potential confounding factors.</p><p><strong>Results: </strong>The prevalence of WLB was 16% (95% confidence interval (CI): 12.2-20.7), whereas the prevalence of capacity to undertake the surgeons' preferred area of practice in orthopaedic surgery was 33% (95%CI: 27.8-38.7), and the availability of a public appointment or the desired mix of private and public work was reported at 24.3% (95%CI: 19.7-29.6). Multivariate analyses revealed that WLB was the most commonly selected reason for practice location among outer metropolitan/regional orthopaedic surgeons. Primary decision-making factors varied based on training location, amount of work conducted in the public sector, and state. Surgeon age, gender, and being trained overseas were not related to practice location choice.</p><p><strong>Conclusions: </strong>Our research indicates that maintaining a healthy work-life balance would allow orthopaedic surgeons in inner regional Australia to work in any location. The growing and accepted use of telehealth, supported by government funding, will be demonstrated on the location of practice by orthopaedic surgeons and other clinicians.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"191"},"PeriodicalIF":2.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236093","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":"Community Specialist Teams for Older Persons (CST-OP) at risk of, or living with frailty in Ireland: a prospective cohort study of a new model of integrated care for community dwelling older adults.","authors":"Christina Hayes, Aoife Whiston, Christine Fitzgerald, Collette Devlin, Brian Condon, Molly Manning, Aoife Leahy, Katie Robinson, Rose Galvin","doi":"10.1186/s12875-025-02895-x","DOIUrl":"10.1186/s12875-025-02895-x","url":null,"abstract":"<p><strong>Background: </strong>This study explored the clinical and process outcomes of older adults at risk of or living with frailty who received an interdisciplinary Comprehensive Geriatric Assessment (CGA) in the community.</p><p><strong>Methods: </strong>This prospective cohort study recruited older adults aged ≥ 75 who were screened for frailty and referred to one of three CST-OP hubs in the Mid-West of Ireland by their GP. Follow-up assessments were conducted via telephone by an independent assessor at 30- and 180-days. The primary outcome was functional status. Secondary outcomes included primary healthcare use, secondary healthcare use, nursing home admission, health-related quality of life (HRQoL), patient satisfaction and mortality.</p><p><strong>Results: </strong>A total of 303 participants (mean age = 83.2 years) were recruited. Incidence of 30- and 180-day functional decline was 26.4% and 33.7% respectively. The majority of older adults who availed of community-based CGA maintained functional independence up to 6-months post index visit. At 30-days, the mortality rate was 1.0%, Emergency Department (ED) presentation 6.9%, hospitalisation 6.6% and nursing home admission 4.0%. HRQoL significantly improved at 30- and 180-days. There was a significant improvement in HRQoL, F(2,542) = 13.8, p < 0.001, η² = 0.5. The presence of frailty was a significant predictor of adverse outcomes.</p><p><strong>Conclusion: </strong>Community-based CGA results in favorable health outcomes including HRQoL among community-dwelling older adults. Community-based CGA may also mitigate against potentially avoidable ED presentations and hospitalisations. Use of the Clinical Frailty Scale is recommended to predict the risk of functional decline, increased rates of mortality, NH admission, hospitalisation or ED presentation at 30- and 180-days among community-dwelling older adults.</p><p><strong>Trial registration: </strong>The study protocol was prospectively registered on Clinicaltrials.gov (NCT05527223). Registered January 09, 2022. https://clinicaltrials.gov ..</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"193"},"PeriodicalIF":2.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236092","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}