BMC primary carePub Date : 2025-04-24DOI: 10.1186/s12875-025-02842-w
Mundih Noelar Njohjam, Niakam Tiffany Falonne, Mark Olivier Ngoule
{"title":"Barriers to medication adherence for secondary stroke prevention in rural communities in Cameroon: a qualitative study.","authors":"Mundih Noelar Njohjam, Niakam Tiffany Falonne, Mark Olivier Ngoule","doi":"10.1186/s12875-025-02842-w","DOIUrl":"https://doi.org/10.1186/s12875-025-02842-w","url":null,"abstract":"<p><strong>Background: </strong>Stroke survivors in rural communities may face unique challenges in accessing and adhering to medications for secondary prevention. This qualitative study aimed to explore the factors associated with medication adherence among stroke survivors in rural settings.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with 15 stroke survivors, 5 caregivers, and 5 healthcare providers in rural communities. We conducted thematic analysis of the data using a grounded theory approach.</p><p><strong>Results: </strong>Six key themes emerged: access (subthemes: inefficient/non-existent healthcare services, limited access to health facilities, shortages of medications), medication-related (subthemes: side effects and polytherapy), patient-level (subthemes: beliefs and knowledge about stroke and medications, attitudes and motivation towards treatment), health system and provider-related (subthemes: quality of patient-provider communication and counselling, shortages of healthcare workers, healthcare workers' knowledge of stroke and medication), economic and environmental barriers (subthemes: poverty, lack of transportation and political conflict), and socio-cultural barriers (subthemes: stigma and social isolation and cultural practices).</p><p><strong>Conclusion: </strong>The barriers to adherence to medications for secondary stroke prevention in the studied rural communities were multifactorial and mostly resulted from preventable health and socioeconomic factors. A multistrategic approach including enhancement of patient education, streamlining medication changes, rural healthcare worker training on secondary stroke prevention, patient counselling and addressing concerns and side effects, community outreach and education to raise awareness about stroke prevention, and the use of single-pill combination therapy can address these barriers and ensure long-term adherence.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"125"},"PeriodicalIF":2.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12023389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060071","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":"Depression care trajectories and associations with subsequent depressive episode: a registry-based cohort study (The Norwegian GP-DEP study).","authors":"Sharline Riiser, Tone Smith-Sivertsen, Valborg Baste, Inger Haukenes, Øystein Hetlevik, Sabine Ruths","doi":"10.1186/s12875-025-02825-x","DOIUrl":"https://doi.org/10.1186/s12875-025-02825-x","url":null,"abstract":"<p><strong>Background: </strong>Depression often has a recurrent course, but knowledge about the impact of treatment trajectories is scarce. We aimed to estimate treatment trajectories for patients with recurrent depression, and to explore associations between the trajectories and subsequent depressive episodes.</p><p><strong>Methods: </strong>Cohort study based on linked registry data, comprising all Norwegian residents ≥ 18 years with an (index) depressive episode in 2012 following previous episode(s) in 2008-2011. We generated multi-trajectories based on treatment during index episode including GP follow-up consultation(s), long consultation(s) and/or talking therapy (with GP), antidepressants, and contact(s) with specialist care. Generalized linear models were used to analyse associations between different treatment trajectories and subsequent depression within one year.</p><p><strong>Results: </strong>The study population consisted of 9 027 patients, mean age 44.6 years, 63.9% women. Five treatment trajectory groups were identified: \"GP 1 month\" (45.2% of the patients), \"GP 6 months\" (31.9%), \"GP 12 months\" (9.3%), \"Antidepressants 12 months\" (9.0%), and\"Specialist 12 months\" (4.6%). In group\"GP 1 month\" (reference), 25.1% had subsequent depression. While trajectory group \"Antidepressants 12 months\", had similar likelihood of subsequent depression as the reference (Relative risk (RR) = 1.04, 95% confidence interval (CI) 0.91-1.18), the groups \"GP 12 months\" (RR = 1.43, CI 1.28-1.59), \"Specialist 12 months\" (RR = 1.26, CI 1.08-1.47) and \"GP 6 months\" (RR = 1.17, CI 1.07-1.26) had increased risk of subsequent depression.</p><p><strong>Conclusions: </strong>Our findings suggest that long-term antidepressant treatment of patients with recurrent depressive episodes may prevent subsequent depression episodes. However, this finding needs to be confirmed through studies that take into account the severity of depression.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"123"},"PeriodicalIF":2.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12023545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047389","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}
BMC primary carePub Date : 2025-04-24DOI: 10.1186/s12875-025-02840-y
Julian Wangler, Stefan Claus, Michael Jansky
{"title":"Approaches towards averting a potential structural shortage of general practitioners: results of a quantitative survey on attitudes, experiences, and ideas from general practitioners in the Federal Republic of Germany.","authors":"Julian Wangler, Stefan Claus, Michael Jansky","doi":"10.1186/s12875-025-02840-y","DOIUrl":"https://doi.org/10.1186/s12875-025-02840-y","url":null,"abstract":"<p><strong>Background: </strong>Securing primary care poses a complex set of challenges for policymakers in national healthcare. The risk of a shortage in general practitioners raises the question as to which approach would make an effective contribution towards averting an impending healthcare shortage. There has been a lack of studies shedding light on how general practitioners pview various approaches towards securing long-term primary care, and which measures they support from their own professional experience. The aim of the study was to ascertain the opinions, attitudes, and experiences of general practitioners in securing primary care across the country. We ran a survey to ask GPs about strategies that they saw as promising or particularly pressing, how they viewed the current situation regarding the shortage of general practitioners, and what they saw as causes for any decline they had already seen in primary care.</p><p><strong>Methods: </strong>Our survey conducted online addressed a total of 5,164 general practitioners interviewed between August 2023 and April 2024 (40% response rate). Apart from descriptive analysis, we used Student's t-test for independent samples to determine significant differences between two groups. We also performed a factor analysis (Varimax rotation).</p><p><strong>Results: </strong>Our respondents displayed a somewhat negative view of primary care development in Germany. Many general practitioners expressed concerns as to whether primary care would remain secure in the long term. Despite partial progress, respondents saw a great need for countermeasures in the coming years. Nearly half of the respondents at 44% saw a noticeable decrease in general practices in their local area. Physicians in small towns and rural communities were more than twice as likely to experience the healthcare shortage due to a decline in general practitioners compared to their colleagues in medium-sized and large cities (42% versus 19%, p<0.001). More than half at 55% reported declining attractiveness in primary care for young physicians, which they attributed to three problem areas: 1) Position of primary care within the healthcare system, 2) Requirements for foundational and continuing medical education, 3) Working conditions. Respondents especially advocated the following approaches toward securing primary care: Establishing a primary care system (88%), more intense promotion of interest in primary care with points of contact in foundational and continuing medical education, especially in accompanying longitudinal programmes (78%), reinforcing multi-professional outpatient care centres (62%), restructuring curricula (54%) and enrolment criteria for medical study courses (51%), and reforming general medical training (55%).</p><p><strong>Conclusions: </strong>General practitioners have their own proposals and preferences to add to the existing assessments and expert opinions. General practitioners should be involved more consistently","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"124"},"PeriodicalIF":2.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12023567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043206","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}
BMC primary carePub Date : 2025-04-23DOI: 10.1186/s12875-025-02799-w
Sarah M Leatherman, Britte Beaudette-Zlatanova, Gregory Robben, Peter A Glassman, Patricia Woods, Ryan E Ferguson, William C Cushman, Areef Ishani
{"title":"Provider experiences with and attitudes about an embedded pragmatic clinical trial.","authors":"Sarah M Leatherman, Britte Beaudette-Zlatanova, Gregory Robben, Peter A Glassman, Patricia Woods, Ryan E Ferguson, William C Cushman, Areef Ishani","doi":"10.1186/s12875-025-02799-w","DOIUrl":"10.1186/s12875-025-02799-w","url":null,"abstract":"<p><strong>Background/aims: </strong>The Diuretic Comparison Project (DCP) was a pragmatic clinical trial comparing rates of cardiovascular events between hydrochlorothiazide or chlorthalidone. VA primary care providers (PCPs) and their patients were participants in the study. Veterans ≥ 65 years taking hydrochlorothiazide were randomized to continue on hydrochlorothiazide or switch to chlorthalidone. Participating providers could decline the randomization of their patients. Providers were surveyed about their experience with DCP, and to ascertain providers' understanding of and attitudes towards embedded pragmatic trials.</p><p><strong>Methods: </strong>A questionnaire was emailed to PCPs that provided informed consent to participate in the study. The survey asked about provider experience with the trial including interest in the study question, awareness of the study and educational materials, impact on the provider-patient relationship, burden of study participation, and their attitudes towards pragmatic trials. Respondents could also add free text comments.</p><p><strong>Results: </strong>There were 180 completed surveys. Of those, most found the trial question of interest (91%) and found the time required to participate in the trial was reasonable (67%). Only 2 (1%) felt the study had a negative impact on the provider-patient relationship. 97% of providers were as comfortable with (59%) or more comfortable with (32%) DCP compared to traditional randomized controlled trials.</p><p><strong>Conclusion: </strong>Responding providers' experience with DCP and their attitudes towards pragmatic trials were positive. Primary care providers indicated willingness to participate in future pragmatic trials if burden is low and it does not negatively impact patient care. Results support continued use of pragmatic embedded clinical trials in primary care.</p><p><strong>Clinical trial registration: </strong>NCT02185417. Registered 9 July 2014. https://clinicaltrials.gov/ct2/show/NCT02185417 .</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"121"},"PeriodicalIF":2.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054629","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":"Requests for physician-assisted suicide in German general practice: frequency, content, and motives- a qualitative analysis of GPs' experiences.","authors":"Luise Farr, Juliane Poeck, Claudia Bozzaro, Jutta Bleidorn","doi":"10.1186/s12875-025-02830-0","DOIUrl":"https://doi.org/10.1186/s12875-025-02830-0","url":null,"abstract":"<p><strong>Background: </strong>Physician-assisted suicide (PAS) has been legalised in an increasing number of countries in Western Europe. In Germany, after a landmark decision by the Federal Constitutional Court in 2020, the ban on PAS was removed from the Model Medical Code of Conduct in 2021. Although the German Medical Association makes it clear that assisted suicide (AS) is not a genuine medical task, doctors have been approached about it. As long-standing, trusted companions of their patients, general practitioners (GPs) can be predestined as initial contacts for requests regarding PAS. Aim of this study is to assess the experiences of German GPs with requests for PAS.</p><p><strong>Methods: </strong>We conducted 19 guideline-based interviews with GPs currently or formerly practicing in Germany (study period: 03/22-12/22). The verbatim transcripts were analysed using Mayring's qualitative content analysis.</p><p><strong>Results: </strong>In contrast to vague death wishes, requests for PAS were described as occasional. Nearly all respondents had experienced them several times. Most interviewees did not observe an increase in requests following the 2020 ruling by the Federal Constitutional Court. So far, the GPs' role in PAS seems to be more of an advisory, informative, caring rather than an actively assisting one. According to the GPs' reports most patients requesting PAS suffered from at least one form of cancer. Another significant group of patients was not severely ill but advanced in age. Regardless of age or illness, the interviewed GPs frequently perceived the loss of autonomy and independence as a primary motive for requesting PAS. Most of the requests involved either the plea for a lethal drug, information on the lethal dose of prescribed medication, or unspecified requests for assistance with suicide. Patients requesting PAS were predominantly described as educated, reflective, and financially well-off individuals.</p><p><strong>Conclusion: </strong>Individual insights into German GPs' experiences with PAS suggest a high probability for GPs to encounter requests for PAS during their practice. Knowledge of vulnerable patient groups and prominent motives behind requests for PAS can be helpful in practice, enabling physicians to better understand and adequately respond to such requests.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"122"},"PeriodicalIF":2.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999201","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}
BMC primary carePub Date : 2025-04-23DOI: 10.1186/s12875-025-02824-y
Piyachon Aramrat, Chanchanok Aramrat, Thomas Taeksung Kim, Muhammad Jami Husain, Soumava Basu, Saudamini Dabak, Wanrudee Isaranuwatchai, Nutchar Wiwatkunupakarn, Apichard Sukonthasarn, Chaisiri Angkurawaranon, Deliana Kostova, Andrew E Moran
{"title":"Costs of the HEARTS hypertension program in primary care in Lampang province, Thailand.","authors":"Piyachon Aramrat, Chanchanok Aramrat, Thomas Taeksung Kim, Muhammad Jami Husain, Soumava Basu, Saudamini Dabak, Wanrudee Isaranuwatchai, Nutchar Wiwatkunupakarn, Apichard Sukonthasarn, Chaisiri Angkurawaranon, Deliana Kostova, Andrew E Moran","doi":"10.1186/s12875-025-02824-y","DOIUrl":"https://doi.org/10.1186/s12875-025-02824-y","url":null,"abstract":"<p><strong>Background: </strong>In 2020, a pilot program for hypertension control was initiated in primary care facilities in Lampang Province, Thailand. The program followed the framework of the HEARTS program for standardized hypertension treatment, but the financial costs of the program are not well understood. This study evaluates the costs of the HEARTS approach compared to usual care to inform future scale-up efforts of the program.</p><p><strong>Methods: </strong>Cost data were collected and analyzed using the HEARTS costing tool, a Microsoft Excel-based tool that supports activity-based costing of the HEARTS program from the health system perspective. Three scenarios were considered: usual care, the HEARTS regimen using standardized hypertension treatment with single-agent pills, and a sub-scenario of the HEARTS regimen using single-pill dual-drug combination pills. Costs are estimated as annual costs from the health system perspective in all Lampang primary care facilities.</p><p><strong>Results: </strong>For the usual care scenario, the HEARTS single-pill scenario, and the HEARTS combination-pill sub-scenario, the average annual medication cost per treated patient was USD 14.0 (THB 485), USD 13.8 (THB 479), and USD 14.3 (THB 497), respectively. Total program cost per primary care user was USD 13.6 (THB 472.7), THB USD 14.3 (494.5), and USD 14.4 (THB 499.9) across the three scenarios, respectively. The largest program cost driver (45-47% across the examined scenarios) was attributed to a comprehensive package of laboratory tests applied to all hypertension patients. Hypothetically, reducing test coverage from all hypertension patients (27% of primary care users) to 15% of primary care users (corresponding to the proportion of patients aged 65+) would reduce program cost per user from USD 14.3 to USD 12.0 in the HEARTS combination-pill scenario.</p><p><strong>Conclusions: </strong>Compared to usual care, HEARTS implementation costs include additional costs for staff training, which are balanced by lower medication expenditures using the HEARTS standardized regimen with single-agent pills. The HEARTS regimen using dual-drug combination pills was estimated to be slightly more costly due to the higher price of combination pills. Optimizing coverage of diagnostic tests and lowering the purchasing prices of combination-pill medicines are key areas for cost reduction in future scale-up efforts.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"120"},"PeriodicalIF":2.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042589","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":"Factors associated with unvoiced concerns of patients attributed to embarrassment, modesty or a fear of being judged.","authors":"Aline Hurtaud, Clémence Laurent, Leïla Bouazzi, Emilie Thery Merland, Coralie Barbe","doi":"10.1186/s12875-025-02804-2","DOIUrl":"https://doi.org/10.1186/s12875-025-02804-2","url":null,"abstract":"<p><strong>Background and objective: </strong>It is important for patients to feel that they can address any topic during a consultation with a General Practitioner (GP), so that the care delivered is appropriate and relevant. This study aimed to investigate factors associated with unvoiced concerns of patients during a GP consultation, because of embarrassment, modesty and/or a fear of being judged.</p><p><strong>Methods: </strong>Cross-sectional, observational study between December 2023 and January 2024, using a ad hoc questionnaire completed by adult subjects who accepted to participate in the study. The factors associated with unvoiced concerns with a p-value < 0.20 by univariable analysis were included in a multivariable logistic regression model.</p><p><strong>Results: </strong>In total, 2104 participants were included (mean age 43.7 ± 15.9 years; 73% women). Of these, 680 (32.3%, (95% CI, 30.3-34.3)) reported that they had leaved unvoiced concerns during the consultation due to embarrassment, modesty and/or a fear of being judged. The main motives for embarrassment, modesty and/or fear of being judged were: \"sexual behavior, libido, perception of your gender, erectile dysfunction, vaginal dryness\" (15% of respondents), and \"psychological disorders, low mood, anxiety\" (14%). Factors associated with a higher likelihood of unvoiced concerns were female sex (adjusted odds ratio (aOR) 1.5 [95% CI 1.2-1.9]; p = 0.0001) and third-level education (aOR 1.3 [95% CI 1.05-1.7]; p = 0.02). Conversely, heterosexuality (aOR 0.7 [95% CI 0.5-0.98]; p = 0.04) and a relationship of trust with the GP (aOR 0.6 [95% CI 0.5-0.7]; p < 0.0001) were associated with a lower likelihood of unvoiced concerns during GP consultation. Forty-seven percent of respondents said that hearing their GP reaffirm the secrecy of anything said during the consultation would have helped them to be more forthcoming, and 78% reported that they would have felt more at ease if the GP had addressed the difficult topic first.</p><p><strong>Conclusion: </strong>Simple tools that could be used during primary care consultations could help to address sensitive issues and create an environment where patients can more comfortably address all their health issues without discomfort.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"118"},"PeriodicalIF":2.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063075","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}
BMC primary carePub Date : 2025-04-22DOI: 10.1186/s12875-025-02805-1
Marianne Dees, Sevde Alkir-Yurt, Gert Olthuis, Jozé Braspenning
{"title":"Determining implementation issues of open notes in primary care: a focus group study.","authors":"Marianne Dees, Sevde Alkir-Yurt, Gert Olthuis, Jozé Braspenning","doi":"10.1186/s12875-025-02805-1","DOIUrl":"https://doi.org/10.1186/s12875-025-02805-1","url":null,"abstract":"<p><strong>Background: </strong>In several countries, patients have online access to medical records (open notes) contributing to patient engagement and healthcare outcomes. However, usage is still low. Healthcare professionals' viewpoints on open notes are under-represented in existing reviews. And a systematic framework to understand the implementation is lacking. Using the 'capability approach', we evaluated the value of open notes by examining influencing factors and capabilities (opportunities and challenges) of patients and staff in general practices.</p><p><strong>Method: </strong>Qualitative research was conducted in 10 Dutch general practices (19 healthcare professionals and 29 patients) that were included through purposive sampling aiming at a diversity of practices and patients. Three focus groups were held with primary care staff and 10 with patients, led by an experienced facilitator using a topic guide. Content analysis was used for the transcripts of the focus groups; coded in ATLAS.ti in three rounds by two researchers independently. The results were discussed with the research team to identify factors and capabilities that could affect the usability of open notes.</p><p><strong>Results: </strong>Personal, social, and environmental factors appeared to influence the use of open notes, such as digital and health literacy, social support from and within the practice, and legislation and regulation. Patients and healthcare professionals agreed on most of these factors. From the capabilities, four implementation themes were identified. First, ambiguity about ownership of medical records and concerns about data integrity should be addressed. Second, the change in practice organization and the care process caused by open notes need practical support. Third, fear of the unknown and unintended consequences of open notes must be considered. Fourth, the introduced change to the healthcare professional-patient relationship requires additional skills. These themes applied to both patients and healthcare professionals, but the differences became clear in the details.</p><p><strong>Conclusion: </strong>The study provides insight into how patients and healthcare professionals experience open notes. Besides the practical barriers and facilitators, patients and healthcare professionals addressed four implementation themes that should guide the further implementation of open notes to improve patient engagement and health outcomes.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"119"},"PeriodicalIF":2.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042600","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}
BMC primary carePub Date : 2025-04-17DOI: 10.1186/s12875-025-02813-1
Helen Anderson, Louise Brady, Joy Adamson
{"title":"Exploring the relationship between cultural and structural workforce issues and retention of nurses in general practice (GenRet): a qualitative interview study.","authors":"Helen Anderson, Louise Brady, Joy Adamson","doi":"10.1186/s12875-025-02813-1","DOIUrl":"https://doi.org/10.1186/s12875-025-02813-1","url":null,"abstract":"<p><strong>Background: </strong>Increasing shortfalls in nursing workforces are detrimental to safety critical patient care. In general practice in England up to one-in-two nursing posts are predicted to be unfilled by 2030/31, with Wales similarly threatened. This is reflected internationally. Limited attention has been paid to how cultural and structural issues affect retention of nurses in general practice. The aim of our study is to understand factors that challenge retention and support nurses to stay in general practice.</p><p><strong>Methods: </strong>We conducted an exploratory qualitative interview study with n = 41 members of nursing teams working in, or who have worked in, general practice as well as nurse leaders associated with general practice across England and Wales. Recruitment was through professional and social media networks and snowballing techniques. Data were analysed following framework analysis and were collected between October 2023-June 2024. University of York ethics approval (Ref: HSRGC/2023/586/A) was gained. The study was funded by the General Nursing Council Trust.</p><p><strong>Results: </strong>Recognition of the value of nurses working in general practice was central to the retention of nurses at all levels of practice and was affected by structural and cultural issues and reflected in several themes: The essence of nursing in general practice; The commodification and deprofessionalisation of nursing in general practice; Opportunities for development; Employment of nurses outside of the National Health Service; Lack of voice, precarity of position and lack of recourse; Tipping points.</p><p><strong>Conclusion: </strong>Cultural and structural issues impacted on retention of nurses in general practice. While some supported retention, others revealed deep-seated, complex issues which require addressing at practice, local and national organisational levels. Nurses in general practice experience factors which leave them vulnerable and underserved. Policy makers, employers and professional organisations need to work to support retention and enable nurses in general practice, not only to survive, but thrive.</p><p><strong>Protocol registration: </strong>Open Science Framework ( https://osf.io/ ) Identifier: DOI https://doi.org/10.17605/OSF.IO/2BYXC https://osf.io/2byxc/ . Protocol published: https://onlinelibrary.wiley.com/doi/ https://doi.org/10.1111/jan.16313.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"114"},"PeriodicalIF":2.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045302","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}
BMC primary carePub Date : 2025-04-17DOI: 10.1186/s12875-025-02817-x
Walaa A Husain, Rabab M Moosa, Ameera M Awadh, Fadak M Aladraj, Bayan Mahdi, Shereen M Haji, Sadok Chlif, Olakunle Alonge, Mohamed H Shehata
{"title":"The prevalence and contributing factors of NSAIDs prescription among chronic kidney disease patients in primary care: a mixed methods study from Kingdom of Bahrain.","authors":"Walaa A Husain, Rabab M Moosa, Ameera M Awadh, Fadak M Aladraj, Bayan Mahdi, Shereen M Haji, Sadok Chlif, Olakunle Alonge, Mohamed H Shehata","doi":"10.1186/s12875-025-02817-x","DOIUrl":"https://doi.org/10.1186/s12875-025-02817-x","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of Non-steroidal Anti-Inflammatory Drugs (NSAIDs) prescription and its contributory factors among chronic kidney disease (CKD) patients are unknown in the Kingdom of Bahrain - though NSAIDs are known to cause significant renal impairment. This study will determine the prevalence of NSAIDs prescription among CKD patients and the contributory factors to this behavior from the perspective of primary care physicians in Bahrain.</p><p><strong>Methodology: </strong>A sequential mixed-method design study comprising of a retrospective cross-sectional survey drawn from patients' electronic medical records (EMR) and qualitative in-depth interviews with primary care physicians (PCPs) was conducted between December 2022 and January 2023 - with an EMR data lookback from 1 st June 2021 to 1 st June 2022 Quantitative descriptive analysis was conducted to estimate the prevalence of NSAIDs and their associations with sociodemographic and service delivery indicators. An Ishikawa diagram was used to describe contributory factors to NSAID prescription among CKD patients drawing from the literature and was used to guide a deductive thematic analysis of the qualitative data.</p><p><strong>Result: </strong>Of the enrolled CKD patient population (4,380 patients), 17.4% had at least one inappropriate NSAID prescription. 80% of these patients had moderate renal impairment, while 19.3% had severe impairment. Most of the prescriptions were in 24-h health centers (48.5%). A Bivariate relationship between the prescription and the sociodemographic factors showed a significant P value regarding age (P-value 0.008*) and the severity of the renal impairment (P-value < 0.001*). The contributory factors were divided into five themes: patient factors, physician factors, health team factors, I SEHA factors and system factors. Of these themes, patients and PCPs were identified by the primary care physicians as some of the most important reasons for NSAIDs prescription among CKD patients.</p><p><strong>Conclusion: </strong>The prevalence of NSAIDs prescription among CKD patients is relatively high in the kingdom of Bahrain - largely due to patient and physician factors as identified by primary care physicians. Possible solutions for addressing these factors include raising awareness among patients, PCPs, and other healthcare workers and activating the Swiss Cheese Model that involves patients, PCPs, and other health team members to ensure appropriate medication practice and patients' safety.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"116"},"PeriodicalIF":2.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060293","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}