BMC primary care最新文献

{"title":"Unlocking value: a comprehensive costing study of primary health care service delivery in Tanzania.","authors":"Federica Margini, Wilson Charles Mahera, Ntuli Kapologwe, James Tumaini Kengia, Dastan Mshana, Raymond Kiwesa, Gabrielle Appleford, Wendy Erasmus, Carl Schutte","doi":"10.1186/s12875-025-02985-w","DOIUrl":"10.1186/s12875-025-02985-w","url":null,"abstract":"<p><strong>Background: </strong>Tanzania has long prioritized primary health care (PHC) as the pathway to achieving universal health coverage. However, greater, and more effective investments are needed to expand access to quality PHC services and further improve population health outcomes. Furthermore, as Tanzania graduated to lower-middle-income country status, the Government is expected to move towards full domestic financing of health services. To support this aim, there is a need to estimate the current expenditure of PHC services, the resources needed to deliver quality PHC services according to nationally defined standards, and the gap between the two.</p><p><strong>Methods: </strong>A top-down approach was used to understand the costs incurred by the government to provide PHC services in public health facilities. All facility and community-level expenditures incurred by the government and development partners on human resources, medicines, medical supplies, and facility operations were collected and included in the costing. The total funding gap was calculated as the difference between actual expenditure and estimated normative cost. The gap analysis was undertaken by input categories and level of facility.</p><p><strong>Results: </strong>Government expenditure on PHC substantially increased between fiscal year (FY) 2021/22 and 2022/23. Nevertheless, the spending level is significantly lower than global benchmarks, and the resources required to deliver quality PHC services according to the basic service standards. Moreover, the analysis revealed there are important differences in the levels of spending per capita across regions and health service delivery productivity.</p><p><strong>Conclusions: </strong>The Government of Tanzania's PHC spending increased significantly over the two years, raising the per capita PHC expenditure and the expenditure per outpatient visit. As the Government of Tanzania increasingly finances health services from domestic sources, a key consideration for long-term planning in the context of declining partner funding is the total amount of funding required to provide quality PHC services equitably to the population. At the same time, a more detailed understanding of current PHC expenditure informs the calculation and estimation of the funding gap.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"307"},"PeriodicalIF":2.6,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253627","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 patient experiences with a mindfulness course in a general practice setting: a qualitative study.","authors":"Julie Kroupa Dupont, Frans Boch Waldorff, Anette Hauskov Graungaard","doi":"10.1186/s12875-025-02970-3","DOIUrl":"10.1186/s12875-025-02970-3","url":null,"abstract":"<p><strong>Background: </strong>This study explored patients' reasons for participating in a mindfulness-based stress reduction (MBSR) course offered by their general practitioner and their experiences and outcomes of the course.</p><p><strong>Method: </strong>Data were obtained through qualitative interviews with ten participants (aged 44-75 years) of European descent, from a general practice in Denmark. The participants had varying levels of stress, anxiety, and depression and had completed a mindfulness course, referred by their respective general practitioners. Participants were required to pay a modest fee to participate. Qualitative interviews were chosen to facilitate an in-depth exploration of participants' subjective experiences and perspectives. Thematic analysis was employed to identify recurring patterns, providing profound insights into participants' experiences. The intervention comprised of a six to eight-week mindfulness-based stress reduction program with weekly sessions of one and a half to two and a half hours duration. The participants were urged to practice mindfulness training for approximately 45 min every day during the course. The practice was supported by audio resources and a manual, covering meditation, yoga, and exercises based on MBSRs framework.</p><p><strong>Results: </strong>Three themes emerged from the thematic analysis: (1) Reasons for patients' participation: Patients enrolled in the course as a response to stress-related symptoms and placed their trust in the recommendations of their general practitioners. (2) Outcomes of the course: Participants gained emotion regulation tools, present-moment awareness, and enhanced coping strategies, resulting in greater control over emotions and a shift towards acceptance and self-awareness, and (3) Integration of mindfulness into daily life: Participants incorporated mindfulness using breathing techniques to cultivate serenity.</p><p><strong>Conclusion: </strong>The study indicates that patients in general practice have a positive attitude towards mindfulness as a part of the stress treatment in general practice. The patient's interest was supported by trustful doctor-patient relationships. The participants experienced improved emotion regulation and enhanced coping strategies. These findings underscore the benefits of integrating mindfulness into general practice. However, mindfulness is not available within Denmark's free healthcare system, limiting its benefits for vulnerable groups.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"305"},"PeriodicalIF":2.6,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245273","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":"Postpartum check-ups with general practitioners in Norway: a cross-sectional survey of attendance, content and patient satisfaction.","authors":"Christine Agdestein, Gunnhild Åberge Vie, Ingrid Baasland, Julie Horn, Bente Prytz Mjølstad","doi":"10.1186/s12875-025-02992-x","DOIUrl":"10.1186/s12875-025-02992-x","url":null,"abstract":"","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"306"},"PeriodicalIF":2.6,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245319","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":"What are the primary care physicians and cardiologists talking about? a cross-sectional analysis of two telemedicine services in Rio de Janeiro, Brazil.","authors":"Leonardo Graever, Sathya Karunananthan, Rafael Aaron Abitbol, Gabriel Pesce de Castro da Silva, Laís Pimenta Ribeiro Dos Santos, Mariana Borges Dias, Marcelo Machado Melo, Viviane Belídio Pinheiro da Fonseca, Leonardo Cançado Monteiro Savassi, Aurora Felice Castro Issa, Anne Frølich, Maria Kátia Gomes, José Roberto Lapa E Silva, Clare Liddy, Helena Dominguez","doi":"10.1186/s12875-025-02989-6","DOIUrl":"10.1186/s12875-025-02989-6","url":null,"abstract":"","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"303"},"PeriodicalIF":2.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240493","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":"Barriers and implementation strategies for physical activity on prescription (PAP): healthcare personnel and management perspectives in Sweden-An explanatory sequential study design.","authors":"Dan Sigvardsson, Anna MacLean, Albin Hoonk, Tahaa Ali, Marlene Makenzius","doi":"10.1186/s12875-025-03038-y","DOIUrl":"10.1186/s12875-025-03038-y","url":null,"abstract":"","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"302"},"PeriodicalIF":2.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240508","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":"Adopting self-measured blood pressure monitoring in underserved primary care settings: a qualitative study using customer discovery and value proposition principles.","authors":"Rasha Khatib, Iridian Guzman, Nicole Glowacki, Julie C Lauffenburger, Mathew Anderson, Nallely Mora","doi":"10.1186/s12875-025-03019-1","DOIUrl":"10.1186/s12875-025-03019-1","url":null,"abstract":"<p><strong>Background: </strong>Despite being recommended in clinical practice guidelines as an effective strategy to control blood pressure, self-measured blood pressure monitoring (SMBP) adoption in the US remains low with clear disparities among underserved patients. Our objective was to develop a prototype SMBP Clinical Integration Package to support the use of standard, cost-effective SMBP devices requiring minimal technology investment for healthcare systems.</p><p><strong>Methods: </strong>The I-Corps™ methodology, designed to promote the successful adoption of interventions, was used to create a value proposition and to conduct customer discovery interviews with hypertension patients, primary care providers, and healthcare system leaders from a Midwestern healthcare system. Interviews were analyzed using rapid qualitative analysis methods. Emerging themes were used to revise the value proposition, create the minimum viable product, and propose an SMBP intervention to increase its adoption in primary care.</p><p><strong>Results: </strong>A total of 28 interviews were conducted. Six themes emerged including (1) access to a blood pressure device with the appropriate cuff size (2), Self-efficacy in performing SMBP (3), motivation to perform SMBP (4), an acceptable pathway to share SMBP readings with the care team (5), processes to document and address SMBP readings, and (6) unmet social needs. Key findings from these interviews suggest the need for an intervention that addresses multifaceted emerging barriers at the patient, provider, and health system levels.</p><p><strong>Conclusions: </strong>The I-Corps™ methodology led to identifying the clinical problem relevant to the SMBP adoption in low resource primary care settings where patients cannot afford enhanced SMBP devices and health systems do not have the resources to invest in high-cost technology solutions. The proposed ASPIRE Clinical Integration Package incorporates the identified minimum valuable product and includes supporting the patient in completing SMBP readings at home, documenting the readings in an acceptable method to the patient, sharing them with the care team to be incorporated into the treatment plan, and addressing the patient's unmet social needs.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"304"},"PeriodicalIF":2.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240470","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":"Capacity and performance of primary health care in Ethiopia: a novel mixed methods measurement in low-income country.","authors":"Shegaw Mulu Tarekegn, Derebe Tadesse, Mesele Damte Argaw, Agumasie Semahegn, Lisanu Taddesse, Salsawit Shifarraw, Wendemagegn Enbiale, Muluken Dessalegn Muluneh, Biruk Abate, Addis Tamire, Misrak Makonnen","doi":"10.1186/s12875-025-02988-7","DOIUrl":"10.1186/s12875-025-02988-7","url":null,"abstract":"<p><strong>Background: </strong>Universal access to essential health services is a global commitment; however, it remains a major challenge in low-income countries. Primary health care (PHC) is widely recognized as the most effective platform for delivering basic health interventions and essential public health functions. Assessing the capacity and performance of PHC provides critical information on the state of the PHC system and supports evidence-based decision-making to inform the design of targeted interventions.</p><p><strong>Methods: </strong>The capacity and performance of the Ethiopian PHC system was assessed using a customized version of World Health organization's PHC Measurement Framework and Indicators (PHCMFI). PHC capacity was assessed across the domains of governance, financing, and input. PHC performance was assessed across domains of service availability and readiness, service quality, utilization, and coverage. Data were primarily obtained from secondary databases, supplemented by primary data collected through sixty-five key informant interviews from all regions of Ethiopia. A review of grey literature and national surveys was also conducted. Indicators for each domain were selected from the PHCMFI, and an unweighted average score was computed for each domain.</p><p><strong>Results: </strong>PHC oriented policies and strategies exist at national and regional levels but with limited implementation capacity. PHC accounted for 78% of the total health expenditure, the per capita PHC expenditure was 28.3 USD and 40% of the source was from out-of-pocket. The average infrastructure score was 55%, essential medicines and basic laboratory diagnostic tests were available in 39% and 48% of facilities, respectively. The health workforce density for core health professional categories was 1.23 per 1,000 population and the average health-information system score was 38%. The average service availability score was 64%. Only 22% of health facilities had trained staff to provide antenatal care (ANC). ANC four or more visit coverage was only 43% and pentavalent 3 coverage was 55.2%.</p><p><strong>Conclusion: </strong>The assessment revealed that the capacity of the Ethiopian PHC is limited in delivering quality health services, and its overall performance remains insufficient to progress towards achieving universal health coverage. The findings call for increasing funding for PHC, improving the availability of basic amenities at PHC units, strengthening logistics management system, designing, and implementing workforce development and motivation mechanisms and improving the availability and readiness of health services at health facilities.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"299"},"PeriodicalIF":2.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194036","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":"Joint consultations in a structured GP-patient-geriatric-psychiatrist model for late-life depression: a cluster RCT.","authors":"Lars Christian Kvalbein-Olsen, Eivind Aakhus, Ole Rikard Haavet, Ibrahimu Mdala, Erik L Werner","doi":"10.1186/s12875-025-03002-w","DOIUrl":"10.1186/s12875-025-03002-w","url":null,"abstract":"<p><strong>Background: </strong>Depression in older adults is mainly treated in general practice but is often constrained by limited resources in primary healthcare services and suboptimal access to assistance from specialized care. This study aimed to evaluate the effectiveness of a structured collaborative model between GPs and geriatric psychiatrists compared to standard follow-up for individuals aged ≥ 65 with depression.</p><p><strong>Methods: </strong>Patients with moderate depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores of 10-19) were invited to participate in a cluster-randomized controlled trial evaluating a structured collaborative intervention model involving GPs and geriatric psychiatrists. The core component of the intervention consisted of two consecutive joint consultations with the GP, patient, and geriatric psychiatrist, supplemented by individual GP-patient consultations. PHQ-9 assessments were conducted at baseline and at 6, 12, and 18 months. The primary outcome was a ≥ 50% reduction in PHQ-9 scores.</p><p><strong>Results: </strong>35 general practitioners initially agreed to participate, yet only 19 managed to recruit one or more depressed patients. Consequently, a total of 34 patients were enrolled in the study, with 30 providing survey responses during the follow-up period for subsequent analysis. Binary analysis (≥ 50% symptom reduction) showed a greater likelihood of improvement in the intervention group compared to the control, though this difference did not reach statistical significance. Notably, both groups showed significant mean PHQ-9 score reductions (3.4 and 4.0, respectively) at 18 months, but differences in mean PHQ-9 scores between the groups across all time points were not statistically significant.</p><p><strong>Conclusion: </strong>This study did not yield significant results for the collaborative model implemented. Major challenges in the recruitment process likely contributed to the low participation rate, which may explain the absence of positive findings.</p><p><strong>Trial registration: </strong>The study was registered the 15.09.2019 in ClinicalTrials.gov with ID: NCT04078282.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"297"},"PeriodicalIF":2.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194008","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":"Association between family doctor contract services and management status among patients with hypertension or diabetes in a multi-ethnic Province of China.","authors":"Ao Zhang, Yingjie Wang, Shilong Zhang, Yuguo Ye, Zucheng Fang, Yuxing Zheng, Gang Cheng, Qingyue Meng, Haipeng Wang","doi":"10.1186/s12875-025-03031-5","DOIUrl":"10.1186/s12875-025-03031-5","url":null,"abstract":"","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"301"},"PeriodicalIF":2.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194034","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":"Prerequisites for implementing accreditation in Iran's comprehensive healthcare centers: a qualitative study.","authors":"Sina Etemadi, Marjan Hedayati Pour, Milad Mehri, Anahita Behzadi","doi":"10.1186/s12875-025-03021-7","DOIUrl":"10.1186/s12875-025-03021-7","url":null,"abstract":"<p><strong>Background: </strong>The primary health care system is acknowledged as the essential entry point to health services. In Iran, primary health care has historically been a key focus for policymakers. However, the accreditation of these services has only recently gained attention as a significant consideration. This study aims to qualitatively examine the prerequisites necessary for the effective implementation of accreditation programs within the primary health care system.</p><p><strong>Methods: </strong>This qualitative study was conducted using semi-structured interviews with a diverse group of participants, including specialists from the Iran Ministry of Health, managers of comprehensive health centers in Kerman, physicians, and representatives from the Deputy of Health at Tehran, Kerman, and Mashhad Universities of Medical Sciences. Purposive sampling was utilized through a snowball approach. Content analysis and MAXQDA12 software were used for data analyzing.</p><p><strong>Results: </strong>The results showed that various factors are prerequisites for the accreditation program. These requirements were subthemes of the three major concepts introduced by Avedis Donabedian, i.e., structure, process, and outcome. Structural challenges encompassed programs, culture, accreditation platforms, evaluation teams, and motivation. Process challenges included program comprehensiveness, financial resource sustainability, implementation leveling, knowledge translation, implementation protocols, comprehensive training, accreditation standards, and system design. On the basis of the Donabedian model, the results section includes the outcome and expected output. With respect to the challenges of the accreditation program, most of the issues raised by the participants were related to the fundamental and structural defects of the country's healthcare system.</p><p><strong>Conclusion: </strong>The challenges faced in the accreditation program are largely rooted in the fundamental and structural defects of the country's healthcare system. The prerequisites for effective accreditation are not limited to the process itself; rather, they are heavily influenced by broader systemic issues related to the program, culture, resources, and overall design of the healthcare infrastructure. Addressing these underlying structural problems is crucial for the successful implementation and sustainability of the accreditation program. In any case, without considering major challenges, the implementation of the accreditation program could face serious problems.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"298"},"PeriodicalIF":2.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194051","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}