BMC primary care最新文献

{"title":"Assessing the reliability and validity for metabolic syndrome diagnosis using point-of-care analyzers in a mobile setup - a pilot study.","authors":"Sanne Houtenbos, Anne Schraplau, Pia-Maria Wippert, Michael Rapp, Heinz Völler, Klaus Bonaventura, Frank Mayer","doi":"10.1186/s12875-026-03502-3","DOIUrl":"10.1186/s12875-026-03502-3","url":null,"abstract":"<p><strong>Background: </strong>The metabolic syndrome (MetS) is characterized by having three or more of these risk factors: increased blood glucose (Glc), serum triglycerides (TG), blood pressure (BP), waist circumference (WC), and reduced high-density lipoprotein (HDL). Mobile diagnostics using point-of-care (POC) blood analyzers could help identify individuals at risk. This pilot study assessed reliability and validity of MetS risk factor analysis using POC analyzers in a mobile examination unit.</p><p><strong>Methods: </strong>Fifty participants (52 ± 7y; 170 ± 10 cm; 80 ± 19 kg, m/f: 21/29) were included for analysis. The mobile examination unit was equipped with different POC analyzers (Alere, LABGEO, CardioChek for Glc, HDL, TG; Quo-Test-A1C Testkit for HbA1c'). Agreement compared to a reference laboratory (RefLab) was analyzed by Bland-Altman (bias, Limits of Agreement (LoA)), ICC, SEM and McNemar's test. Test-retest analysis was assessed on two different days (max. two weeks apart) using Spearman's rho, ICC, test-retest variability (TRV%) and McNemar's test.</p><p><strong>Results: </strong>Based on the smallest bias and low number of missing values (Glc: -5 [LoA - 25 to 6] mg/dl; TG: 8 [LoA - 58 to 30] mg/dl; HDL: -2 [LoA - 14 to 9] mg/dl), and the highest agreement in MetS diagnosis compared to the results of RefLab, the Alere POC device was chosen. Test-retest reliability (n = 16) for MetS risk factors and HbA1c measured in the mobile setup ranged from poor to excellent with low TRV (0.9-5.8%). Risk factor classification and MetS diagnosis did not differ between measurement days.</p><p><strong>Conclusions: </strong>A mobile setup using the Alere POC analyzer could be used as a valid mobile screening method for MetS to ensure early detection of risk factors.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802282","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":"Improving breast and colorectal cancer screening information through co-design with underserved groups in an urban area.","authors":"Olga C Damman, Loebna Sabbah, Danielle R M Timmermans, Abanoub Iskander, Ingeborg S van Strien-Knippenberg","doi":"10.1186/s12875-026-03522-z","DOIUrl":"10.1186/s12875-026-03522-z","url":null,"abstract":"<p><strong>Background: </strong>Certain groups participate less in Dutch population-based breast cancer (BC) and colorectal cancer (CRC)-screening, such as people with lower socio-economic status or ethnic minorities in deprived urban areas. We aimed to investigate the perspective and underlying needs of underserved groups regarding information provision about BC- and CRC- screening, and to design novel information strategies accordingly. The ultimate aim was to reach them more effectively and support informed decision-making.</p><p><strong>Methods: </strong>In total, 28 co-design sessions were conducted in deprived neighborhoods of Amsterdam, the Netherlands, for four backgrounds separately, i.e., Moroccan, Turkish, Surinamese, and no migrant background. We performed 16 sessions with women (N = 44; 4 sessions per group; 40-78 yrs) about BC- and CRC-screening, and 12 with men (N = 28; 3 sessions per group; 54-79 yrs) about CRC-screening. Creative assignments, summaries, and field notes were analyzed using thematic analysis.</p><p><strong>Results: </strong>Three overall themes were identified. First, there was very limited knowledge about BC and CRC and the idea of screening for these cancers, which made it difficult for people to relate cancer screening information in general to existing knowledge structures. Second, people were in an early stage of the decision-making process, with positive but largely uninformed attitudes towards BC- and CRC-screening. Third, although participation in cancer screening was generally considered desirable, it was not a priority in daily life. Especially people with a migrant background emphasized that invitations via post were easily missed/forgotten. Co-designed novel information strategies included group information sessions in local communities, short awareness/information flyers, and audiovisual information in multiple languages.</p><p><strong>Conclusions: </strong>People from underserved populations recognized the importance of BC- and CRC-screening in taking care of their health. However, findings suggested that some key information did not come across, due to a mismatch between information content typically provided -focusing on cancer screening- and basic knowledge and information needs of the participants. Additionally, there was a mismatch between typical information delivery (i.e. post) and how participants said to handle information in their daily lives. Co-designed strategies can be utilized by screening organizations.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13681932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225537","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":"\"We could do more\": exploring violance prevention measures in German outpatient primary care - a qualitative study.","authors":"Stefanie Mache, Monika Bernburg, Annika Würtenberger, David A Groneberg, Volker Harth","doi":"10.1186/s12875-026-03509-w","DOIUrl":"10.1186/s12875-026-03509-w","url":null,"abstract":"<p><strong>Background: </strong>Healthcare workers in general practice are exposed to verbal and physical violence from patients and accompanying persons. While research has predominantly focused on hospital settings, evidence on violence prevention in primary care remains limited. General practice staff often report feeling insufficiently prepared to manage aggressive behaviour. This study explored staff perceptions of violence prevention measures in outpatient care, including perceived usefulness, implementation barriers, and unmet needs.</p><p><strong>Methods: </strong>A qualitative study was conducted involving 45 semi-structured interviews with physicians and medical assistants working in direct patient care in German general practices. Interviews explored experiences with violence prevention measures, perceived usefulness, barriers to implementation, and additional needs. Data were analysed using qualitative content analysis according to Mayring.</p><p><strong>Results: </strong>Participants described environmental (e.g., alarm systems), organisational (e.g., staff organisation and practice procedures), and individual-level measures (e.g., communication strategies and staff training) for violence prevention in ambulatory care. Violence prevention was perceived as a multi-layered organisational process rather than a single intervention. In many practices, formal violence prevention guidelines or standard operating procedures were absent, insufficiently implemented, or perceived as impractical for routine care. Exploratory comparisons suggested that these overarching themes were largely consistent across practice settings, professions, and gender, with contextual differences primarily reflecting professional roles and organisational circumstances.</p><p><strong>Conclusions: </strong>Violence prevention in general practice requires a systematic, multi-level approach addressing environmental, organisational, and individual factors. Adequate staffing and manageable workloads appear central to enabling consistent implementation of preventive strategies across different primary care contexts. Practice-specific guidance should be developed, communicated, and integrated into routine care to support structured responses to aggression. Future research should further explore and evaluate tools for early identification of patients at risk of aggression and examine how contextual factors influence the implementation and effectiveness of violence prevention strategies in primary care.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690471","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":"Peritonsillitis in primary care: patient characteristics and care pathways - a population-based registry study.","authors":"Jon Pallon, Katarina Hedin","doi":"10.1186/s12875-026-03486-0","DOIUrl":"10.1186/s12875-026-03486-0","url":null,"abstract":"<p><strong>Background: </strong>Peritonsillitis, including peritonsillar abscess and cellulitis, is a common deep neck infection often considered a complication of pharyngotonsillitis. However, population-based data on patient characteristics, clinical presentation, and care pathways are limited.</p><p><strong>Methods: </strong>We conducted a population-based registry study in Region Kronoberg, Sweden (2012-2016), including all episodes of peritonsillitis and pharyngotonsillitis diagnosed in primary health care (PHC) and hospitals. New episodes were defined as diagnoses separated by ≥ 30 days. Patient characteristics, recent pharyngotonsillitis, and referral pathways between PHC and specialist care were described. Incidence rates and temporal trends were estimated to provide population context.</p><p><strong>Results: </strong>A total of 607 peritonsillitis episodes were identified in 555 patients. Incidence peaked in late adolescence and young adulthood, remained low in children and older adults, and showed no sex differences within age groups. Only 23% of episodes were preceded by pharyngotonsillitis within 30 days (median interval: 2 days), increasing to 29% when restricting the analysis to cases confirmed in the ear, nose, and throat (ENT) department. Most patients (74%) were first diagnosed in PHC, and 71% of these were subsequently managed in the ENT department. Overall, 85% of all episodes involved initial PHC management. Incidence of peritonsillitis declined over time in parallel with pharyngotonsillitis at the population level.</p><p><strong>Conclusions: </strong>Peritonsillitis predominantly affects adolescents and young adults and commonly presents without a recent documented sore throat. PHC plays a central role in initial assessment and referral, with most patients subsequently managed in specialist care. These findings provide population-level insights into patient characteristics and care pathways, with implications for early recognition and management in PHC.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686793","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":"Attitudes of Swedish primary care physicians toward GLP-1 receptor agonists for overweight and obesity: a cross-sectional survey.","authors":"Isabelle Sundell, Björn Wettermark, Anders Sundström, Mats Martinell, Björn Ericsson, Ulf Lindahl, Hussein N Rubaiy, Maria Palmetun Ekbäck","doi":"10.1186/s12875-026-03488-y","DOIUrl":"10.1186/s12875-026-03488-y","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a growing global health burden, previously with few effective treatments. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were originally approved for diabetes but are increasingly prescribed for treatment of overweight and obesity. The increasing expenditure has led to ethical debates surrounding the utilization of these drugs. Few studies have investigated the attitudes to GLP-1 RAs among prescribing physicians. This study aimed to assess the attitudes to GLP-1 RAs for treatment of overweight and obesity among Swedish primary care physicians.</p><p><strong>Methods: </strong>This was a cross-sectional survey with descriptive quantitative analysis and thematic analysis of free-text responses. A mix of multiple-choice questions and rating scales, including the Likert scale was employed. The study was conducted in October 2024 among physicians working in primary care in the Swedish regions of Gävleborg, Uppsala, Västernorrland, Västmanland and Örebro. The survey was distributed through the Drug and Therapeutics Committees (DTCs) in the regions.</p><p><strong>Results: </strong>The 190 responses yielded a response rate of 28%. Of these, 163 responses could be included in the final analysis. Almost all respondents (98%) agreed that GLP-1 RAs are effective drugs for treating obesity, and 91% believed they will be important for obesity treatment in the future. Main identified barriers for prescribing GLP-1 RAs were high patient co-payment (69%) and low drug availability due to supply shortages at the time of conducting this survey (86%).</p><p><strong>Conclusion: </strong>Physicians working in primary care in Sweden consider GLP-1 RAs effective for treating obesity and believe these drugs will play an important role in obesity treatment in the future. These findings should be interpreted in the light of the low response rate and possible self-selection bias.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680423","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 primary care physicians in Germany consider meaningful and meaningless work: a qualitative interview study using reflexive thematic analysis.","authors":"Joséphine-Charlotte Coleman, Alina Stortz, Matthias Stadler, Martin R Fischer, Marion Huber, Katharina Schütte-Nütgen, Tago L Mharapara, James R Greenslade-Yeats, Matthias J Witti","doi":"10.1186/s12875-026-03495-z","DOIUrl":"10.1186/s12875-026-03495-z","url":null,"abstract":"<p><strong>Background: </strong>Germany faces a critical shortage of primary care physicians (PCPs). A protective factor against job turnover is the experience of meaningful work. While the presence of meaning fosters work engagement and well-being, its absence can lead to career exit. This qualitative study explores perceptions of meaningful and meaningless work among German PCPs to inform health policies and help minimize career exit.</p><p><strong>Methods: </strong>We implemented a qualitative study design, conducting online, one-on-one, semi-structured interviews with 24 PCPs practicing across Germany. Participants were recruited through purposive and snowball sampling to ensure a representative sample. We evaluated the data using reflexive thematic analysis.</p><p><strong>Results: </strong>We generated five central themes. Meaning is derived from realizing professional identity through autonomous medical expertise (theme 1) and cultivating trust-based, long-term patient relationships on an equal footing (theme 2). Conversely, meaninglessness arises through unrealistic patient expectations and physicians' experiences of frustration (theme 3), and systemic devaluation through administrative burdens and inadequate compensation (theme 4). The resulting disillusionment (theme 5) increases the risk of career exit.</p><p><strong>Conclusions: </strong>Our findings show that the projected PCP shortage in Germany may stem in part from a \"crisis of meaning\". Current billing structures prioritize high-volume transactional encounters, which obstruct the very tasks that PCPs find meaningful. To ensure workforce stability, policy reforms must move beyond individual resilience and address these systemic drivers of meaninglessness.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13429019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148655110","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":"Sleep quality and anxiety among final-year medical interns during a family medicine clerkship: a cross-sectional study with implications for primary care training.","authors":"Elif Keskin Çolak, Erhan Şimşek","doi":"10.1186/s12875-026-03500-5","DOIUrl":"10.1186/s12875-026-03500-5","url":null,"abstract":"<p><strong>Background: </strong>Sleep problems and anxiety are common but often under-recognised concerns in primary care. Final-year medical interns, who are medical students undertaking their final year of supervised clinical training, represent an important group for sleep health research because they face clinical responsibilities and concerns related to night shifts, emergency department work, direct patient care, and career-related stressors. This study aimed to evaluate sleep quality and its association with anxiety among medical interns during a Family Medicine clerkship.</p><p><strong>Methods: </strong>This single-centre cross-sectional study was conducted at Ankara Yıldırım Beyazıt University Faculty of Medicine between June 2023 and September 2023. Data were collected from medical interns during their Family Medicine clerkship. Participants with previously diagnosed psychiatric disorders or sleep disorders were excluded. Face-to-face questionnaires were used, including a sociodemographic and lifestyle characteristics form, the Pittsburgh Sleep Quality Index, and the Beck Anxiety Inventory. Descriptive statistics, comparative analyses, correlation analysis, and multivariable logistic regression analysis were performed to evaluate factors associated with poor sleep quality.</p><p><strong>Results: </strong>A total of 219 medical interns were included. Poor sleep quality was identified in 59.4% of participants. The mean Pittsburgh Sleep Quality Index score was 6.59 ± 3.36, the mean sleep duration was 6.73 h, and the mean Beck Anxiety Inventory score was 9.63 ± 8.45. Pittsburgh Sleep Quality Index and Beck Anxiety Inventory scores were positively correlated (r = 0.320, p < 0.001). In the multivariable logistic regression model, higher BAI scores, sex, and self-reported concern about taking night shifts were associated with poor sleep quality. Each one-point increase in the BAI score was associated with higher odds of poor sleep quality (odds ratio [OR] = 1.075; 95% confidence interval [CI]: 1.021-1.131; p = 0.006), while self-reported concern about taking night shifts was associated with 2.48-fold higher odds (OR = 2.483; 95% CI: 1.160-5.317; p = 0.019). Female sex was associated with lower odds of poor sleep quality compared with male sex (OR = 0.513; 95% CI: 0.265-0.994; p = 0.048); however, this finding was less robust in sensitivity analyses and should be considered exploratory.</p><p><strong>Conclusion: </strong>Poor sleep quality was common among medical interns and was associated with higher anxiety symptoms and self-reported concern about taking night shifts. These findings support consideration of sleep health and anxiety-related concerns within Family Medicine training. However, the cross-sectional design does not permit causal inference, and intervention studies are needed to determine whether educational, screening, or supportive approaches improve interns' well-being or future clinical practice.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How relational continuity shapes recommended chronic disease management: analysis of population-based administrative health data in British Columbia.","authors":"Eric Poarch, Mark Asbridge, Cindy Feng, David Rudoler, Rebecca H Correia, Ridhwana Kaoser, Sandra Peterson, Rita McCracken, Andrew Putman, François Gallant, Ruth Lavergne","doi":"10.1186/s12875-026-03482-4","DOIUrl":"https://doi.org/10.1186/s12875-026-03482-4","url":null,"abstract":"<p><strong>Background: </strong>Relational continuity, or the ongoing therapeutic relationship between patient and clinician, has been associated with improved outcomes among people with chronic disease and emphasized in primary care policy. It has not yet been studied how relational continuity shapes recommended chronic disease management and whether this relationship is modified by patient complexity.</p><p><strong>Methods: </strong>We used linked administrative health data to conduct a retrospective, population-based cohort study among residents of British Columbia, Canada with diabetes and/or hypertension between April 1, 2020 to March 31, 2023. Modified-Poisson regression models were used to calculate adjusted risk ratios (aRR) between relational continuity and a composite outcome of recommended management (including monitoring and prescribing for diabetes or hypertension) and included interaction terms to examine subgroup-specific associations among those treated for serious mental illness, substance use disorder, or with a higher overall burden of comorbidity.</p><p><strong>Results: </strong>Compared to those with low relational continuity, those with complete relational continuity had slightly more recommended management for both diabetes (20.4% vs. 19.2%) and hypertension (28.4% vs. 26.8%). However, when adjusting for other patient characteristics, there was a null association between relational continuity and recommended management overall (aRR: 1.00, 95% confidence interval [CI] 0.99 to 1.01). We note significant inverse associations among those treated for serious mental illness (SMI) or with high comorbidity, particularly with high primary care use (12 + visits and SMI aRR: 0.64 [0.52-0.80]; 12 + visits and Charlson comorbidity score > 1 aRR: 0.91 (0.86-0.96)]).</p><p><strong>Conclusions: </strong>Relational continuity was not associated with recommended chronic disease management processes. Inverse associations observed among patient subgroups with more complex needs suggests that emphasis on visit-based measures of relational continuity has been ineffective at facilitating complex care. Improving other aspects of continuity, like management and informational continuity, may be important to providing comprehensive and equitable primary care.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229481","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":"Spanish experience of an extensively hydrolyzed formula with lactose and human milk oligosaccharides in cow's milk allergy.","authors":"Cristóbal Coronel-Rodríguez, Marta Castell Miñana, Miquel Layola Brias","doi":"10.1186/s12875-026-03481-5","DOIUrl":"10.1186/s12875-026-03481-5","url":null,"abstract":"<p><strong>Background: </strong>Despite the evidence supporting the efficacy of extensively hydrolyzed formulas (eHF) and human milk oligosaccharides (HMO) for the management of cow's milk protein allergy (CMPA), data on their use in clinical practice remain limited. The objective of the study was to describe the current landscape of CMPA management in Spanish primary care consultations, with particular emphasis on eHFs and novel immunomodulatory components (purified lactose or HMO).</p><p><strong>Methods: </strong>ELEVA was a multicenter, descriptive, ecological study involving 191 pediatricians with experience on CMPA management. Aggregated data derived from their experience on CMPA management.</p><p><strong>Results: </strong>The eHFs were the most commonly prescribed first-line option for mild and moderate CMPA (78.5% and 95.8%, respectively), while elemental formulas were mainly used in severe cases (61.8%). Infants who received an eHF supplemented with purified lactose and two HMO improved their digestive symptoms (77.4%), showed a reduction of crying and/or irritability symptoms (63.1%), normalization of stool consistency (51.6%), avoidance the rejection/difficulty for eating (48.2%), or a reduction of the number of stools (44.9%).</p><p><strong>Conclusions: </strong>The ELEVA study offers detailed insights into how pediatricians in Spain manage CMPA in clinical practice. It also highlights the integration of innovative tools, such as the CoMiSS™ awareness tool for CMPA diagnosis, and novel treatment components like purified lactose and HMO. The use of an eHF supplemented with purified lactose and HMO appears effective in alleviating digestive issues and irritability symptoms. Additionally, it may influence the incidence of infections, use of medication, and number of visits to the healthcare center.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13681903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225511","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":"Challenges of the general practitioner's role in integrated primary health care: a qualitative study of trainees in a reform-oriented network in Northern Italy.","authors":"L Marchesi, A F Azzolini, E Tobaldini, A Corraro, L M Bracchitta, B D'Avanzo, A Nobili, A De Simoni","doi":"10.1186/s12875-026-03420-4","DOIUrl":"10.1186/s12875-026-03420-4","url":null,"abstract":"<p><strong>Background: </strong>Integrated primary health care (PHC) is essential for efficient, equitable healthcare, especially amid rising chronic conditions and an aging population. It ensures coordinated care across services, with GPs as key gatekeepers. Yet, European systems face obstacles like service fragmentation, workforce shortages, inadequate funding, digital barriers, inconsistent policies and poor integration across services.</p><p><strong>Objective: </strong>This study explores the perspectives of trainee doctors in Northern Italy on the challenges of integrated PHC and suggests best practices to enhance integrated care and GP training.</p><p><strong>Methods: </strong>This is a qualitative study using semi-structured remote interviews, analyzed using data-driven thematic analysis. Eligible participants were regional and university-based trainees.</p><p><strong>Results: </strong>Twelve participants (7 F, 5 M, aged 25-49y, 8 regional and 4 university-based trainees) were recruited. All shared a good understanding of integrated PHC challenges, such as managing patients with chronic conditions and limitations of the digital infrastructure for interoperability across primary, secondary, community, and social care services. They noted that service fragmentation, increased patient access to online health information and remote consultations have shifted patient expectations and disrupted traditional primary care dynamics, making it more challenging for GPs to promote integrated care. Rural areas are facing shrinking local health services, lack of staff and reduced capacity to provide integrated care comparable to urban settings. Participants emphasized the importance of team-based care and the need for both bottom-up initiatives (e.g., self-initiated collaborations with local care providers) and top-down support mandated by policy, such as dedicated regular meetings during office hours and clinical governance initiatives. They shared examples of good practices that could be incorporated in future policies, such as on-call secondary care specialists available for phone consultation to prevent unnecessary referrals. Participants also highlighted the importance of quality standards in GP training and the need to develop competencies in effective team-based working.</p><p><strong>Conclusions: </strong>This study highlights key challenges and actionable solutions proposed by GP trainees to improve integrated care and training, offering insights relevant to health systems beyond Italy. Although based on more engaged and reform-minded trainees, this calls for more research on this group of future primary care professionals, who may be key to informing interventions to improve integrated PHC.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"27 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931977","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}