BMC primary care最新文献

{"title":"People living with chronic pain in Canada face difficult decisions and decisional conflict concerning their care: data from the national DECIDE-PAIN survey.","authors":"Florian Naye, France Légaré, Chloé Cachinho, Thomas Gérard, Karine Toupin-April, Maxime Sasseville, Jean-Sébastien Paquette, Annie LeBlanc, Isabelle Gaboury, Marie-Eve Poitras, Linda C Li, Alison M Hoens, Marie-Dominique Poirier, Yannick Tousignant-Laflamme, Simon Décary","doi":"10.1186/s12875-024-02667-z","DOIUrl":"https://doi.org/10.1186/s12875-024-02667-z","url":null,"abstract":"<p><strong>Background: </strong>Shared decision-making is an imperative in chronic pain care. However, we know little about the decision-making process, especially in primary care where most chronic pain care is provided. We sought to understand decisional needs of people living with chronic pain in Canada.</p><p><strong>Methods: </strong>We conducted a population-based cross-sectional online survey of random samples of adults living in Canada with chronic noncancer pain and registered with the Leger Marketing panel. We followed the International Association for Study of Pain definition of chronic pain (i.e., persistent or recurrent pain lasting longer than three months). We used a stratified proportional random sampling based on the population and chronic pain prevalence of each province to achieve representativeness. Based on the Ottawa Decision Support Framework, we collected data on difficult decisions (i.e., decision with more than one option and no clear best option) related to their chronic pain condition, the level of decisional conflict associated with the most difficult decisions (i.e., Decisional Conflict Scale), the assumed and preferred role during the decision-making process (i.e., Control Preferences Scale), and respondents' characteristics. We used descriptive quantitative analyses of survey responses.</p><p><strong>Results: </strong>Of the 31,545 invited panellists, 2,666 met the eligibility criteria, and 1,649 respondents from the 10 Canadian provinces completed the survey. Respondents had diverse socio-demographic profiles. Mean age was 51.8 years (SD = 16.3). Half were men (51.4%), most lived in urban areas (87.8%), mean pain duration was 8.5 years (SD = 9.6), and respondents reported an average number of painful body regions of 2.3 (SD = 1.5). We observed that 96.7% of respondents faced at least one difficult decision across their care pathways. These difficult decisions were related to numerous issues from the medical consultation, diagnosis, treatment, and daily life. Almost half of respondents made their most difficult decision with a primary care physician. One third of respondents experienced a high level of clinically significant decisional conflict (Decisional Conflict Scale score ≥ 37.5). Two-thirds of respondents self-reported having a collaborative role during their decision while three-quarters wanted this role.</p><p><strong>Conclusions: </strong>People living with chronic pain in Canada have unmet decisional needs and need support to make optimal decisions to manage their chronic pain. Our findings will guide future development of interventions to implement shared decision-making, especially to support primary care where discussions about difficult decisions often occur.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"424"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing \"what matters most\" to reduce mental health stigma in primary healthcare settings: a qualitative study in Lebanon.","authors":"Racha Abi Hana, Eva Heim, Pim Cuijpers, Marit Sijbrandij, Rabih El Chammay, Brandon A Kohrt","doi":"10.1186/s12875-024-02680-2","DOIUrl":"https://doi.org/10.1186/s12875-024-02680-2","url":null,"abstract":"<p><strong>Background: </strong>\"What matters most\" (WMM) is a theoretical framework based on medical anthropology and draws on cultural concepts of values and morals. It has been employed to identify cross-cultural aspects of mental health stigma. This approach assists practitioners, advocates, and researchers in assessing stigma-related factors that are relevant to the experiences of individuals in diverse cultural contexts. To implement effective anti-stigma programmes it is vital to identify and prioritize WMM for primary healthcare providers and people with lived experience of mental health conditions (PWLE). Our current objective was to explore WMM to primary healthcare providers, PWLE, primary care managers, and policymakers in Lebanon to inform mental health stigma reduction initiatives.</p><p><strong>Methods: </strong>We conducted a total of 45 qualitative interviews with primary healthcare providers, PWLE, primary care managers, and policymakers. The WMM framework was applied to analyse data from primary healthcare centres in Lebanon to identify themes related to stigma against PWLE. The analysis identified common themes related to WMM. The analysis aimed to identify (a) WMM values for participants, (b) factors that threaten these WMM values and their relationship to stigma, and (c) potential interventions that could leverage WMM principles to reduce stigma.</p><p><strong>Results: </strong>WMM for primary healthcare providers encompassed competency, time management, willingness, and self-care. WMM for PWLE focused on equality, support, compassion, and confidentiality. Policymakers emphasised resource sustainability as a top priority. Myths about mental health illnesses perpetuated threats to WMM, and organisational barriers also threatened WMM for primary healthcare providers and PWLE, thus creating major roadblocks to achieving stigma reduction.</p><p><strong>Conclusion: </strong>This study identified key domains to understand the factors for WMM in reducing mental health stigma in Lebanon and explored factors that shape the values and priorities of both PWLE and primary healthcare providers. The study suggests assessing the effectiveness of anti-stigma interventions that actively engage PWLE in their design and implementation, while exploring the broader applicability of the WMM framework across different cultural and healthcare settings.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"427"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General practitioners experience multi-level barriers to implementing recommended care for hip and knee osteoarthritis: a qualitative study.","authors":"Alison J Gibbs, Christian J Barton, Nicholas F Taylor, Joanne L Kemp, Jason A Wallis, Jo-Anne Manski-Nankervis, Allison M Ezzat","doi":"10.1186/s12875-024-02658-0","DOIUrl":"https://doi.org/10.1186/s12875-024-02658-0","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led osteoarthritis management programs and advanced practice triage services are effective, but GPs views on them are largely unknown. This study aimed to explore general practitioner perspectives on: (1) managing patients with hip and knee osteoarthritis, and (2) physiotherapy-led osteoarthritis care and referral pathways.</p><p><strong>Methods: </strong>Interview topic guides were developed based on the theoretical domains framework. Twenty-five semi-structured interviews with GPs were conducted. All data were coded independently by at least two researchers and analysed inductively using thematic analysis, with barrier themes mapped to the socioecological model.</p><p><strong>Results: </strong>Two interrelated themes were identified: (i) GPs had good general knowledge of recommended osteoarthritis care, but (ii) they faced multi-level challenges facilitating or directly providing evidence-based care. Nearly all GPs identified exercise as first-line care and surgery as a last resort. Most were aware imaging was not required to diagnose osteoarthritis, yet reported often referring for imaging. Many GPs expressed challenges facilitating patient engagement in physiotherapy due to patient, environmental/social and system level barriers. Key barriers included: perceived patient expectations and lack of motivation to attend physiotherapy, a lack of knowledge of available physiotherapy services, a lack of affordable physiotherapy services, and lengthy waiting times for public orthopaedic appointments. Having private health insurance was perceived as an enabler.</p><p><strong>Conclusions: </strong>Despite having good knowledge of guideline-recommended care, GPs in our study experienced multi-level barriers to implementing this care in practice. Public health information and strategies to address patient's beliefs and lack of motivation to exercise may help reduce barriers to engaging in appropriate care. Urgent health system funding reforms are needed to allow GPs to appropriately manage patients with hip and knee osteoarthritis.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"423"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Signing contracts for family doctors, functional limitations and home care willingness among older adults: a cross-sectional study.","authors":"Shujun Chai, Dan Zhao, Tingting Gao, Jingjie Sun, Peilong Li, Xueqing Wang, Xuehong Wang, Jingjing Luo, Jiayan Li, Chengchao Zhou","doi":"10.1186/s12875-024-02661-5","DOIUrl":"https://doi.org/10.1186/s12875-024-02661-5","url":null,"abstract":"<p><strong>Background: </strong>Traditional Chinese culture advocates home care be provided by family members. Home care can improve mental health and enjoy a familiar environment for older people. This study aimed to investigate the relationship between signing contracts for family doctors and home care willingness, as well as the interaction effect of functional limitations in this relationship.</p><p><strong>Methods: </strong>This study was based on the sixth National Health Service Survey of Shandong province, China in 2018. A total of 8,055 older adults aged ≥ 60 years were included in the study. The logistic regression models were employed to examine the role of functional limitations in the relationship between signing contracts for family doctors and home care willingness.</p><p><strong>Results: </strong>There were 6,891 (85.55%) participants had home care willingness in Shandong province, China. Compared to respondents who did not have family doctors, older adults with family doctors were more likely to report higher levels of home care willingness after adjusted for covariates (OR = 1.45, 95% CI: 1.27, 1.66). The interaction effect between signing contracts for family doctors and functional limitation on choosing home care for older adults was statistically significant (OR = 0.68, 95% CI: 0.47, 0.97).</p><p><strong>Conclusions: </strong>The association between signing contracts for family doctors and home care willingness varies by functional limitations. Therefore, there is a need to improve social security system and family doctor service policy to suit the care needs of older people, especially those without functional limitations. Social care institutions should also provide comfortable care to disabled older adults as an effective complement.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"422"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating academic detailing as an antibiotic stewardship intervention in primary healthcare settings in Croatia.","authors":"Darija Kuruc Poje, Domagoj Kifer, Maja Kuharić, Katarina Gvozdanović, Željka Draušnik, Ana Posavec Andrić, Vesna Mađarić, Vlatka Janeš Poje, Marina Payerl-Pal, Arjana Tambić Andrašević, Juraj Mark Poje, Vesna Bačić Vrca, Srećko Marušić","doi":"10.1186/s12875-024-02679-9","DOIUrl":"https://doi.org/10.1186/s12875-024-02679-9","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory tract infections are common in primary healthcare care settings and frequently result in antibiotic prescriptions, despite being primarily viral. There is scarcity of research examining impact of academic detailing (AD) intervention on prescribing practices for these infections in resource-constrained healthcare settings like southeastern Europe. Therefore aim of this study was to evaluate impact of AD intervention as an antimicrobial stewardship measure on antibiotic prescribing for acute respiratory tract infections in primary setting in Croatia which is located in southeastern Europe. Secondary goal included examining incidence of Clostridioides difficile infections (CDI) which are often associated with antibiotic consumption.</p><p><strong>Methods: </strong>AD intervention was implemented from 1st to 30th April 2020 and led by hospital healthcare professionals (infectious disease physician, clinical microbiology physician and clinical pharmacist). They focused on enhancing prescribing behaviors of primary care physicians (PCPs) by presenting local data, supplemented by examples from everyday practice, research and guidelines highlighting negative consequences of imprudent antibiotic use. This feasibility quasi-experimental study had two control groups in two counties. Impact of AD intervention was assessed by analyzing antibiotic prescription patterns using log-linear model, adjusting for seasonality. Study focused on prescribed daily defined doses (DDD) per day among PCPs pre-intervention (from 01st January 2018 to 31st March 2020) and post-intervention (from 1st May 2020 to 31st December 2022).</p><p><strong>Results: </strong>Data was collected from sixteen out of fifty-seven eligible PCPs with mean 29 years (SD 11.38) in practice. Statistically significant difference results (p < 0.05) favored AD intervention, leading to 30% decline in antibiotic prescribing in adjusted DDD per day for acute pharyngitis (21.14 post-intervention/30.27 pre-intervention), 33% decline for acute tonsilitis (24.91/37.38), 23% decline for acute upper respiratory infection (21.26/27.62) and 36% decline for acute bronchitis (8.13/12.77). Although there was 14% decline for acute sinusitis post-intervention, it did not reach statistical significance (30.96/35.93) (p = 0.617). Incidence of CDI cases decreased in investigated county while in control county stayed the same. Inter-county difference in these changes was not statistically significant (ratio = 0.749, 95% CI, 0.460-1.220; p = 0.246).</p><p><strong>Conclusions: </strong>This feasibility study showed reductions in antibiotic prescribing for acute respiratory tract infections, emphasizing the efficacy of targeted, educator-led programs. Tailored healthcare strategies are vital, especially in Croatia and southeastern Europe, for promoting sustainable practices and addressing antimicrobial resistance challenges.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"426"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of family health centres in preventing paediatric emergency department usage of parents of children with non-urgent conditions.","authors":"Ahmet Butun","doi":"10.1186/s12875-024-02673-1","DOIUrl":"https://doi.org/10.1186/s12875-024-02673-1","url":null,"abstract":"<p><strong>Background: </strong>Overcrowding in paediatric emergency departments (PEDs) has become a global public health issue, reducing healthcare quality, increasing dissatisfaction, and driving up costs. Overcrowding in PEDs not only affects patient satisfaction and healthcare costs but also can lead to burnout among healthcare professionals. This burnout could potentially result in suboptimal care for truly severe cases, ultimately increasing morbidity and mortality rates among patients requiring urgent attention. This study aims to determine how family health centres can reduce paediatric visits to PEDs and provide recommendations for alleviating overcrowding.</p><p><strong>Methods: </strong>This study is a descriptive cross-sectional study. Participants were parents whose children were admitted to the PED at a tertiary hospital located in southeast Turkey. The data were collected between 15/05/2024-26/08/2024. This study was completed with 657 parents. A convenience sampling method was used to recruit participants. SPSS 11.5 software was used for data analysis.</p><p><strong>Results: </strong>The mean age of the parents and children brought to the PED was 31.99 ± 8.51 years and 4.20 ± 4.08 years, respectively. Of the children, 32.1% were admitted to the PED due to fever. Majority of parents (65%) visited the PED outside working hours. 8.8% of parents considered their child's health condition as \"very urgent\", 54.5% of them considered it as \"urgent\". The majority of parents thought that the PEDs were overcrowded (82.2%). 50.4% of the parents stated that they trusted the PED, and 52.7% stated that they were satisfied with the PED. More than half of the parents (61.8%) stated that they did not visit their family health centre before visiting the PED. 10.8% of parents reported that they had never visited a family health centre in the last year. Majority of parents (62.7%) stated that they will visit the PED again if their children have the same health problems in the future.</p><p><strong>Conclusion: </strong>Improving the use of family health centres, introducing out-of-hours services, and enhancing parents' health literacy could shift non-urgent visits from PEDs to primary care settings. In addition, making parents more aware of services provided in family health centres could affect parents' health-seeking behaviours and choose to use their GP rather than PED for their children with non-urgent conditions.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"420"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-oriented unsupervised learning to uncover the patterns of multimorbidity associated with stroke using primary care electronic health records.","authors":"Marc Delord, Xiaohui Sun, Annastazia Learoyd, Vasa Curcin, Charles Wolfe, Mark Ashworth, Abdel Douiri","doi":"10.1186/s12875-024-02636-6","DOIUrl":"https://doi.org/10.1186/s12875-024-02636-6","url":null,"abstract":"<p><strong>Background: </strong>We aimed to identify and characterise the longitudinal patterns of multimorbidity associated with stroke.</p><p><strong>Methods: </strong>We used an unsupervised patient-oriented clustering approach to analyse primary care electronic health records (EHR) of 30 common long-term conditions (LTC) in patients with stroke aged over 18, registered in 41 general practices in south London between 2005 and 2021.</p><p><strong>Results: </strong>Of 849,968 registered patients, 9,847 (1.16%) had a record of stroke and 46.5% were female. The median age at record of stroke was 65.0 year (IQR: 51.5-77.0) and the median number of LTCs in addition to stroke was 3 (IQR: 2-5). We identified eight clusters of multimorbidity with contrasted socio-demographic characteristics (age, gender, and ethnicity) and risk factors. Beside a core of 3 clusters associated with conventional stroke risk-factors, minor clusters exhibited less common combinations of LTCs including mental health conditions, asthma, osteoarthritis and sickle cell anaemia. Importantly, complex profiles combining mental health conditions, infectious diseases and substance dependency emerged.</p><p><strong>Conclusion: </strong>This novel longitudinal and patient-oriented perspective on multimorbidity addresses existing gaps in mapping the patterns of stroke-associated multimorbidity not only in terms of LTCs, but also socio-demographic characteristics, and suggests potential for more efficient and patient-oriented healthcare models.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"419"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing primary care concepts in higher education: a mixed method study in Flanders (Belgium).","authors":"Lotte Vanneste, Sam Pless, Sandra Martin, Emily Verté, Roy Remmen, Pauline Boeckxstaens, Peter Pype, Reini Haverals, Dagje Boeykens, Dominique Van de Velde, Patricia De Vriendt","doi":"10.1186/s12875-024-02670-4","DOIUrl":"https://doi.org/10.1186/s12875-024-02670-4","url":null,"abstract":"<p><strong>Background: </strong>The policy shift towards person-centred integrated primary care systems drives interest in primary care across higher education programs. In Flanders, the Primary Care Academy (PCA) is established to support this policy shift. The PCA focusses on the concepts of goal-oriented care, self-management, and interprofessional collaboration to support the shift towards integrated care and to integrate them in curricula in order to strengthen and develop a futureproof health system. Therefore, the aim of this study is if and how lecturers implement these concepts in the curriculum and what they need for a successful implementation.</p><p><strong>Methods: </strong>A sequential explanatory mixed method study design was used combining quantitative and qualitative data. A cross-sectional survey was sent to 276 Flemish health care education programs. Qualitative data was collected through focus groups in which lecturers participated.</p><p><strong>Results: </strong>The results showed that 89% of the higher education programs address goal-oriented care, self-management, and interprofessional collaboration with regard to primary care. Further analysis of courses within the programs reveals that the concept of self-management is covered in only 58%, while goal-oriented care (73%) and interprofessional collaboration (80%) appear more frequently. The level at which the themes are addressed in the courses are often limited to an introduction. The focus groups revealed that primary care is present in education programs, however lecturers are limited aware where primary care is integrated in their own and other programs. Lectures expressed a need for more collaboration between research, education and practice in developing educational content. When new concepts are introduced, lecturers want them to be translated into educational content, learning objectives and competencies.</p><p><strong>Conclusions: </strong>The study shows that the concepts of goal-oriented care, self-management, and interprofessional collaboration are present in higher education programs to a varying degree. Lecturers are eager to implement these new primary concepts but they lack collaboration between education, research and practice. Lecturers indicate the need for a competence profile for primary care professionals as common framework to guide curriculum development.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"418"},"PeriodicalIF":2.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to establishing teledermatoscopy in primary health care in Sweden.","authors":"Nils Hernström, Åsa Ingvar","doi":"10.1186/s12875-024-02678-w","DOIUrl":"https://doi.org/10.1186/s12875-024-02678-w","url":null,"abstract":"<p><strong>Introduction: </strong>Teledermatoscopy (TDS) has proven to be effective and reliable for diagnosis of skin malignancies. The factors that determine the success of implementation of TDS are largely unknown.</p><p><strong>Objectives: </strong>To investigate barriers to implementation of TDS in primary health care (PHC) at center and individual level.</p><p><strong>Methods: </strong>Following introduction of TDS, cross-sectional quantitative data and free text comments were collected by surveys sent to PHC centers and PCH practitioners. Successful implementation was defined as regularly sent cases at center level and self-reported usage at individual level. Factors associated with implementation were evaluated with Chi-square, Kruskal-Wallis test and logistic regression.</p><p><strong>Results: </strong>93/117 (78.2%) of PHC centers and 239/725 (32.9%) of PHC practitioners answered the surveys. 54.8% (n = 51) of PHC centers and 64.3% (n = 153) of PHC practitioners had implemented TDS. There was a strong association between hardware arrival before introduction and TDS usage at center level (OR 6.0; 95% CI 1.5-24.3). At individual level, male sex was positively associated with usage (OR 1.9; 95%, CI 1.0-3.4), and for every year of increased age, the chance of using TDS decreased with 3% (OR 1.0, 95% CI 0.9-1.0). No other factor was associated with implementation. \"Good\" was the most common overall impression (54.8%), and the majority found no problems using the system (> 85%). The most common complaint was technical issues followed by no added value.</p><p><strong>Conclusions: </strong>Successful implementation of TDS was strongly associated with hardware arrival at center level, and to male sex and younger age at individual level. Satisfaction was overall high.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"417"},"PeriodicalIF":2.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary care in rural areas: a qualitative study on medical students' images and experiences of working in rural areas in southern Germany.","authors":"Jan Gehrmann, Niklas Barth, Tom Brandhuber, Pascal O Berberat, Sophie Gigou, Antonius Schneider","doi":"10.1186/s12875-024-02677-x","DOIUrl":"https://doi.org/10.1186/s12875-024-02677-x","url":null,"abstract":"<p><strong>Background: </strong>Rural areas are increasingly moving back into the focus of social research, especially in the context of health care. As the shortage of general practitioners (GP) in rural areas is a significant challenge in Germany, there are several programs to counteract underuse effectively, acutely, and sustainably. One of those programs is 'Beste Landpartie Allgemeinmedizin' (BeLA), which was developed to strengthen primary care in rural areas and to sustainably promote young doctors to work as general practitioners in rural regions through didactical and financial support. The program includes an accompanying qualitative study exploring the motivational structures of medical students from a sociological perspective. For this study, the nexus of working in rural areas from the perspective of medical students with different forms of rural experiences was of interest.</p><p><strong>Methods: </strong>Qualitative interviews have been conducted at regular intervals on an ongoing basis since 2020 to investigate motivational retention effects during the program. The current 33 interviews were analysed using the sociological conceptual framework of spatial methods.</p><p><strong>Results: </strong>The images and experiences of working in rural areas condition medical education in various ways. In addition to general images of living and working in rural areas in a biographical dimension, the idea of working as a GP in rural areas includes images of specific medical competencies and is conditioned by different medical tasks. From such a perspective, the images and attributions of working in primary care in a rural region demonstrate particularities, challenges, and the potential attractiveness of working in rural regions.</p><p><strong>Discussion: </strong>The images and experiences of rural areas condition medical education in various ways and shape the expectations and the decision-making of possibly working in rural areas. The particularities, opportunities, and challenges of working in rural areas, which relate to both professional aspects and social life, are a major factor in the attractiveness of a potential rural practice. Didactical and educational curricula need to adapt the various attributions of working in rural areas.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"416"},"PeriodicalIF":2.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}